Provider Demographics
NPI:1508288036
Name:THAI, ELIZABETH N (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:N
Last Name:THAI
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-504-5678
Mailing Address - Fax:
Practice Address - Street 1:750 TOWNPARK LN NW
Practice Address - Street 2:KAISER PERMANENTE TOWNPARK MEDICAL CENTER
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5579
Practice Address - Country:US
Practice Address - Phone:770-739-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2022-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA2558363AM0700X
GA007098363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical