Provider Demographics
NPI:1780665703
Name:ELLIOTT, ANGELIA H (MD)
Entity Type:Individual
Prefix:
First Name:ANGELIA
Middle Name:H
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 1:503 CLARK ST NE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-1921
Mailing Address - Country:US
Mailing Address - Phone:256-739-1759
Mailing Address - Fax:256-739-0027
Practice Address - Street 1:1912 AL HIGHWAY 157
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0609
Practice Address - Country:US
Practice Address - Phone:256-737-2682
Practice Address - Fax:256-737-2152
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22784207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009960750Medicaid
E873OtherMEDICARE GROUP ID #
AL51501647OtherBCBS OF AL
AL051501647Medicare ID - Type Unspecified
AL51501647OtherBCBS OF AL