Provider Demographics
NPI:1518104348
Name:PHELPS, ELAINE F (RN,CNP)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:F
Last Name:PHELPS
Suffix:
Gender:F
Credentials:RN,CNP
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:F
Other - Last Name:GRANGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,CNP
Mailing Address - Street 1:25 BERKSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-8089
Mailing Address - Country:US
Mailing Address - Phone:404-583-5552
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2208
Practice Address - Country:US
Practice Address - Phone:404-686-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN116530363LA2200X
GARN116530NP363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine