Provider Demographics
NPI:1407226236
Name:CHILDRESS, ELIZABETH D (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:D
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SKIDAWAY VILLAGE WALK STE B
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31411-2962
Mailing Address - Country:US
Mailing Address - Phone:912-598-6322
Mailing Address - Fax:912-809-4995
Practice Address - Street 1:4 SKIDAWAY VILLAGE WALK STE B
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31411-2962
Practice Address - Country:US
Practice Address - Phone:912-598-6322
Practice Address - Fax:912-809-4995
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN218397163W00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse