Provider Demographics
NPI:1497074298
Name:ELLIOTT, LASHAUN DENISE (MD)
Entity Type:Individual
Prefix:
First Name:LASHAUN
Middle Name:DENISE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3359 BRIDLE RUN TRL NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1785
Mailing Address - Country:US
Mailing Address - Phone:917-500-4799
Mailing Address - Fax:
Practice Address - Street 1:4651 ROSWELL RD STE I803
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3023
Practice Address - Country:US
Practice Address - Phone:678-819-7777
Practice Address - Fax:678-845-5855
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68404207QA0505X, 2083A0300X, 2083P0901X, 208VP0000X, 208D00000X
NY261986208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine