Provider Demographics
NPI:1760883201
Name:ELMER ANTHONY MUSARRA II
Entity Type:Organization
Organization Name:ELMER ANTHONY MUSARRA II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:MR
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MUSARRA
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:770-421-1242
Mailing Address - Street 1:120 VANN ST NE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7357
Mailing Address - Country:US
Mailing Address - Phone:770-421-1242
Mailing Address - Fax:770-424-6652
Practice Address - Street 1:120 VANN ST NE
Practice Address - Street 2:SUITE 150
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7357
Practice Address - Country:US
Practice Address - Phone:770-421-1242
Practice Address - Fax:770-424-6652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0130692086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD42244Medicare UPIN