Provider Demographics
NPI:1396270294
Name:ELITE PRIME HEALTH
Entity type:Organization
Organization Name:ELITE PRIME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MALINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:901-573-7374
Mailing Address - Street 1:3270 WALTON RIVERWOOD LN SE
Mailing Address - Street 2:3056
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3561
Mailing Address - Country:US
Mailing Address - Phone:901-573-7374
Mailing Address - Fax:
Practice Address - Street 1:3270 WALTON RIVERWOOD LN SE
Practice Address - Street 2:3056
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3561
Practice Address - Country:US
Practice Address - Phone:901-573-7374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13630363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty