Provider Demographics
NPI:1376601641
Name:HERNANDEZ, ELIZABETH LORENA (CASE MANAGEMENT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:LORENA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CASE MANAGEMENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4185 SUMMIT GATE DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6491
Mailing Address - Country:US
Mailing Address - Phone:404-578-1843
Mailing Address - Fax:678-714-1753
Practice Address - Street 1:4185 SUMMIT GATE DR
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6491
Practice Address - Country:US
Practice Address - Phone:404-578-1843
Practice Address - Fax:678-714-1753
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00957602AMedicaid