Provider Demographics
NPI:1497061998
Name:HIMMELSBACH, ELIZABETH (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:HIMMELSBACH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:SALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:535 CHASERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8326
Mailing Address - Country:US
Mailing Address - Phone:706-395-5089
Mailing Address - Fax:855-766-3948
Practice Address - Street 1:535 CHASERIDGE DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-8326
Practice Address - Country:US
Practice Address - Phone:706-395-5089
Practice Address - Fax:855-766-3948
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ08306100213E00000X
NY65 006401213E00000X
GAPOD001161213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist