Provider Demographics
NPI:1720036957
Name:ELLIOTT, CYNTHIA LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LAWRENCE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8719
Mailing Address - Country:US
Mailing Address - Phone:770-822-1090
Mailing Address - Fax:770-513-9735
Practice Address - Street 1:600 PROFESSIONAL DR
Practice Address - Street 2:SUITE 260
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7651
Practice Address - Country:US
Practice Address - Phone:770-822-1090
Practice Address - Fax:770-513-9735
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025997207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00295611BMedicaid
GA00295611BMedicaid
GA11BDLSMMedicare ID - Type Unspecified