Provider Demographics
NPI:1417952508
Name:BOLTON-HARRIS, ELIZABETH KAY (ACNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KAY
Last Name:BOLTON-HARRIS
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:KAY
Other - Last Name:BOLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 COLLIER RD NW
Mailing Address - Street 2:STE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1709
Mailing Address - Country:US
Mailing Address - Phone:404-355-9815
Mailing Address - Fax:404-350-0529
Practice Address - Street 1:275 COLLIER RD NW
Practice Address - Street 2:STE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1709
Practice Address - Country:US
Practice Address - Phone:404-355-9815
Practice Address - Fax:404-350-0529
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA135282363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP57671Medicare UPIN
GA50BBHDVMedicare PIN