Provider Demographics
NPI:1396929840
Name:VANCE, COURTNEY ELAINE (MD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:ELAINE
Last Name:VANCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:COURTNEY
Other - Middle Name:ELAINE
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:DEPARTMENT OF PATHOLOGY EMORY UNIVERSITY HOSPITAL
Mailing Address - Street 2:1364 CLIFTON RD NE
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-0001
Mailing Address - Country:US
Mailing Address - Phone:404-727-4283
Mailing Address - Fax:
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:EMORY UNIVERSITY HOSPITAL DEPARTMENT OF PATHOLOGY
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1059
Practice Address - Country:US
Practice Address - Phone:404-727-4283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA66096207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPENDINGMedicaid
PENDINGOtherRAILROAD MEDICARE
GAPENDINGMedicare PIN