Provider Demographics
NPI:1750494605
Name:BANKS, ELIZABETH DAVIDSON (RN, FNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DAVIDSON
Last Name:BANKS
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 PRINCETON WAY NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1132
Mailing Address - Country:US
Mailing Address - Phone:404-633-5636
Mailing Address - Fax:
Practice Address - Street 1:1525 CLIFTON RD NE
Practice Address - Street 2:SUITE 207
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-4200
Practice Address - Country:US
Practice Address - Phone:404-778-4451
Practice Address - Fax:404-778-4355
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA123620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA782088810AMedicaid
GA782088810AMedicaid