Provider Demographics
NPI:1881044659
Name:ELITE MEDICAL SERIVES OF GEORGIA
Entity Type:Organization
Organization Name:ELITE MEDICAL SERIVES OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:CULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-469-5011
Mailing Address - Street 1:45 FAIRWAY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5421
Mailing Address - Country:US
Mailing Address - Phone:678-469-5011
Mailing Address - Fax:
Practice Address - Street 1:7100 PEACHTREE DUNWOODY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-1689
Practice Address - Country:US
Practice Address - Phone:678-469-5011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE MEDICAL SERIVES OF GEORGIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA65394208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty