Provider Demographics
NPI:1770181273
Name:ELDER, JOSEPH MERRITT
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MERRITT
Last Name:ELDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1784 E PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-2742
Mailing Address - Country:US
Mailing Address - Phone:404-274-5520
Mailing Address - Fax:
Practice Address - Street 1:700 HIGHWAY 29 N
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-1544
Practice Address - Country:US
Practice Address - Phone:706-715-3740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0179561835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist