Provider Demographics
NPI:1710290218
Name:ELSTAD, ADRIENNE C (NCCPA)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:C
Last Name:ELSTAD
Suffix:
Gender:F
Credentials:NCCPA
Other - Prefix:MISS
Other - First Name:ADRIENNE
Other - Middle Name:C
Other - Last Name:CHARRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NCCPA
Mailing Address - Street 1:3400 OLD MILTON PKWY # C
Mailing Address - Street 2:STE 290
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3707
Mailing Address - Country:US
Mailing Address - Phone:770-667-4337
Mailing Address - Fax:770-667-4338
Practice Address - Street 1:960 JOHNSON FERRY RD STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1601
Practice Address - Country:US
Practice Address - Phone:404-252-9063
Practice Address - Fax:404-252-0873
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005700363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA749565882EMedicaid
GA749565882GMedicaid
GA749565882FMedicaid
GA749565882EMedicaid