Provider Demographics
NPI:1750350013
Name:ELLIOTT, PAULA JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:JEAN
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAULA
Other - Middle Name:JEAN
Other - Last Name:PATULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 740209
Mailing Address - Street 2:DEPT. 1029
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0209
Mailing Address - Country:US
Mailing Address - Phone:941-360-1566
Mailing Address - Fax:941-358-9818
Practice Address - Street 1:550 PEACHTREE STREET
Practice Address - Street 2:SUITE 1600
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2209
Practice Address - Country:US
Practice Address - Phone:404-253-6820
Practice Address - Fax:404-874-1249
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044984207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000831421Medicaid
GA05BDKFZMedicare ID - Type Unspecified
GA000831421Medicaid