Provider Demographics
NPI:1649219338
Name:WARD, ELIZABETH CHRISTOPHE (PA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CHRISTOPHE
Last Name:WARD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1960 S 16TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6676
Practice Address - Country:US
Practice Address - Phone:910-662-6000
Practice Address - Fax:910-662-6000
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101705363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1649219338Medicaid
NC8101031Medicaid
SC2256PAMedicaid
NC1649219338Medicaid
NC2749248AMedicare PIN
NC970007208Medicare PIN
NC2749248BMedicare PIN
NC2749248Medicare PIN
NC8101031Medicaid
NC1022110001Medicare NSC
R40503Medicare UPIN
SC2256PAMedicaid