Provider Demographics
NPI:1538636592
Name:FERCILIEN, ELENA VICTORIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:VICTORIA
Last Name:FERCILIEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ELENA
Other - Middle Name:VICTORIA
Other - Last Name:GARIFALLOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1361 JENNINGS MILL RD STE 201
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7292
Mailing Address - Country:US
Mailing Address - Phone:706-316-1908
Mailing Address - Fax:706-316-2062
Practice Address - Street 1:1361 JENNINGS MILL RD STE 201
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7292
Practice Address - Country:US
Practice Address - Phone:706-316-1908
Practice Address - Fax:706-316-2062
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9277363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00958625AMedicaid