Provider Demographics
NPI:1366847709
Name:BUTLER, ELIZABETH REBMANN (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:REBMANN
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:960 JOHNSON FERRY RD STE 130
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1601
Mailing Address - Country:US
Mailing Address - Phone:404-300-2990
Mailing Address - Fax:404-300-2986
Practice Address - Street 1:960 JOHNSON FERRY RD STE 130
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1601
Practice Address - Country:US
Practice Address - Phone:404-300-2990
Practice Address - Fax:404-300-2986
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0181291363A00000X
GA9847363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant