Provider Demographics
NPI:1740476787
Name:BOARD, ELIZABETH M (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:BOARD
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1549 BROOKHAVEN HL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2579
Mailing Address - Country:US
Mailing Address - Phone:770-667-3006
Mailing Address - Fax:770-667-3311
Practice Address - Street 1:5755 N POINT PKWY
Practice Address - Street 2:SUITE 74
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1142
Practice Address - Country:US
Practice Address - Phone:770-667-3006
Practice Address - Fax:770-667-3311
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2014-01-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA042184208D00000X, 171100000X, 174400000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171100000XOther Service ProvidersAcupuncturist
No174400000XOther Service ProvidersSpecialist
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA042184OtherGA STATE LICENSE