Provider Demographics
NPI:1972755718
Name:KIRKLEY, ELIZABETH R (CNM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:KIRKLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:R
Other - Last Name:SUNDAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:699 CHURCH ST. NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1122
Mailing Address - Country:US
Mailing Address - Phone:770-422-8700
Mailing Address - Fax:770-425-7601
Practice Address - Street 1:699 CHURCH ST. NE
Practice Address - Street 2:SUITE 300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1122
Practice Address - Country:US
Practice Address - Phone:770-422-8700
Practice Address - Fax:770-425-7601
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN152838367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA898378846AMedicaid