Provider Demographics
NPI:1720499460
Name:DOUGLAS, ELYSIA
Entity Type:Individual
Prefix:
First Name:ELYSIA
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 GREENMONT DOWNS TRCE
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-3457
Mailing Address - Country:US
Mailing Address - Phone:678-667-4893
Mailing Address - Fax:
Practice Address - Street 1:135 GREENMONT DOWNS TRCE
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-3457
Practice Address - Country:US
Practice Address - Phone:678-667-4893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula