Provider Demographics
NPI:1184888620
Name:SPOSARO, ELIZABETH JOY (MPH, MSN, C-PNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JOY
Last Name:SPOSARO
Suffix:
Gender:F
Credentials:MPH, MSN, C-PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 RED MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-2861
Mailing Address - Country:US
Mailing Address - Phone:770-707-2549
Mailing Address - Fax:
Practice Address - Street 1:173 BOULEVARD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1313
Practice Address - Country:US
Practice Address - Phone:404-658-1500
Practice Address - Fax:404-658-1535
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN122781363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics