Provider Demographics
NPI:1457408767
Name:ANTONY, ELSA G (AA)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:G
Last Name:ANTONY
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5671 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 530
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-5000
Mailing Address - Country:US
Mailing Address - Phone:404-257-1415
Mailing Address - Fax:404-851-1649
Practice Address - Street 1:5665 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1701
Practice Address - Country:US
Practice Address - Phone:404-851-7324
Practice Address - Fax:404-843-2627
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2010-09-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA004627367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA460905230AMedicaid
GA32BBBSCMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER