Provider Demographics
NPI:1578552881
Name:BOTHA, ELEANOR GELLER (MS)
Entity Type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:GELLER
Last Name:BOTHA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:ELEANOR
Other - Middle Name:DENISE
Other - Last Name:GELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2165 N DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5307
Mailing Address - Country:US
Mailing Address - Phone:404-778-8517
Mailing Address - Fax:404-778-8562
Practice Address - Street 1:2165 N DECATUR RD
Practice Address - Street 2:OF HUMAN GENETICS/DIVISION OF MEDICAL GENETICS
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5307
Practice Address - Country:US
Practice Address - Phone:404-778-8517
Practice Address - Fax:404-778-8562
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
No1744R1102XOther Service ProvidersSpecialistResearch Study