Provider Demographics
NPI:1689128902
Name:STOKES, ELLIOT (PA)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:
Last Name:STOKES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 PEACHTREE PKWY STE 302
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6834
Mailing Address - Country:US
Mailing Address - Phone:770-772-1830
Mailing Address - Fax:470-253-8215
Practice Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:#4101
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4539
Practice Address - Country:US
Practice Address - Phone:770-831-5525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA8170363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program