Provider Demographics
NPI:1821063991
Name:TAGHECHIAN, ELIZABETH R (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:TAGHECHIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:699 CHURCH ST NE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1116
Mailing Address - Country:US
Mailing Address - Phone:770-422-8505
Mailing Address - Fax:770-424-7449
Practice Address - Street 1:699 CHURCH ST NE
Practice Address - Street 2:SUITE 220
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1116
Practice Address - Country:US
Practice Address - Phone:770-422-8505
Practice Address - Fax:770-424-7449
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA051190207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00960638AMedicaid
GA00960638CMedicaid
GA00960638BMedicaid
GA324013OtherWELLCARE
GA7975393OtherAETNA
GA10051338OtherAMERIGROUP
GA9027424-004OtherCIGNA
GA288877OtherBCBS
GA7975393OtherAETNA
GA10051338OtherAMERIGROUP
GA00960638BMedicaid