Provider Demographics
NPI:1679956411
Name:ELABLAOUI, DESIREE (CNM)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:ELABLAOUI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 CLEARVIEW AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-2137
Mailing Address - Country:US
Mailing Address - Phone:770-451-3100
Mailing Address - Fax:
Practice Address - Street 1:11975 MORRIS RD STE 300
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4444
Practice Address - Country:US
Practice Address - Phone:770-521-2295
Practice Address - Fax:770-255-0333
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN234276367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife