Provider Demographics
NPI:1699188128
Name:ELLIOTT, TRENTON C (MD)
Entity Type:Individual
Prefix:DR
First Name:TRENTON
Middle Name:C
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:395 CENTRAL PARK PL NE UNIT 640
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:659 AUBURN AVE NE STE 156
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1976
Practice Address - Country:US
Practice Address - Phone:404-888-0228
Practice Address - Fax:404-888-0552
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA260031207R00000X
GA077870207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA077870OtherGA MEDICAL LICENSE