Provider Demographics
NPI:1639182033
Name:WILLINGHAM, ELIZABETH S (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:S
Last Name:WILLINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:SHUGERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5670 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 1280
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1699
Mailing Address - Country:US
Mailing Address - Phone:404-257-1589
Mailing Address - Fax:404-303-1950
Practice Address - Street 1:5670 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 1280
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1699
Practice Address - Country:US
Practice Address - Phone:404-257-1589
Practice Address - Fax:404-303-1950
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA062633207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA278273024AMedicaid
GAI58968Medicare UPIN
GAA40229Medicare UPIN