Provider Demographics
NPI:1861628463
Name:SMALL, ELIZABETH MARSHBURN (PA)
Entity Type:Individual
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First Name:ELIZABETH
Middle Name:MARSHBURN
Last Name:SMALL
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Gender:F
Credentials:PA
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Mailing Address - Street 1:5665 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1764
Mailing Address - Country:US
Mailing Address - Phone:404-252-6104
Mailing Address - Fax:404-257-1808
Practice Address - Street 1:5665 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1764
Practice Address - Country:US
Practice Address - Phone:404-252-6104
Practice Address - Fax:404-257-1808
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2013-11-20
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Provider Licenses
StateLicense IDTaxonomies
GA005553363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical