Provider Demographics
NPI:1386642072
Name:FARMER, ELIZABETH (PT, ATC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:FARMER
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MEDICAL DR NE
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-8005
Mailing Address - Country:US
Mailing Address - Phone:770-386-5221
Mailing Address - Fax:770-386-1128
Practice Address - Street 1:15 MEDICAL DR NE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-8005
Practice Address - Country:US
Practice Address - Phone:770-386-5221
Practice Address - Fax:770-386-1128
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3757225100000X
GAPT007601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000972254AMedicaid
GA000972254GMedicaid
GAP00320623OtherRR MEDICARE
GA000972254GMedicaid