Provider Demographics
NPI:1578132437
Name:COURSEY, ELIZABETH ANNE (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:COURSEY
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP-PC
Mailing Address - Street 1:10700 MEDLOCK BRIDGE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8455
Mailing Address - Country:US
Mailing Address - Phone:678-910-9955
Mailing Address - Fax:
Practice Address - Street 1:10700 MEDLOCK BRIDGE RD STE 102
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-8455
Practice Address - Country:US
Practice Address - Phone:678-691-5351
Practice Address - Fax:770-685-1241
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN255063363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics