Provider Demographics
NPI:1427397082
Name:ELBERT COUNTY INTERNAL MEDICINE, L.L.C.
Entity Type:Organization
Organization Name:ELBERT COUNTY INTERNAL MEDICINE, L.L.C.
Other - Org Name:ELBERT COUNTY INTERNAL MEIDICINE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HILARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLELAND
Authorized Official - Suffix:
Authorized Official - Credentials:HILARIA CLELAND
Authorized Official - Phone:706-549-8682
Mailing Address - Street 1:PO BOX 1468
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30603-1468
Mailing Address - Country:US
Mailing Address - Phone:706-549-8682
Mailing Address - Fax:706-549-8684
Practice Address - Street 1:740 PRINCE AVENUE
Practice Address - Street 2:BUILDING 13
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5906
Practice Address - Country:US
Practice Address - Phone:706-549-6882
Practice Address - Fax:706-549-8684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037175207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty