Provider Demographics
NPI:1205807435
Name:STEVES, ELMA MERA (MD)
Entity type:Individual
Prefix:
First Name:ELMA
Middle Name:MERA
Last Name:STEVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3624 CHAMBLEE TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4418
Mailing Address - Country:US
Mailing Address - Phone:770-938-9401
Mailing Address - Fax:770-938-8222
Practice Address - Street 1:3624 CHAMBLEE TUCKER RD
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-4418
Practice Address - Country:US
Practice Address - Phone:770-938-9401
Practice Address - Fax:770-938-8222
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010080174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00639944AMedicaid
GA60054OtherAETNA PROVIDR ID
GA14108OtherBLUE CROSS PROVIDER ID
GA7018326OtherCIGNA ID
GA1060048OtherQUALITY CARE ID