Provider Demographics
NPI:1821838541
Name:EMANUEL, ELIZABETH ANN (LDO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:EMANUEL
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15328 US HIGHWAY 19 S
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31757-4824
Mailing Address - Country:US
Mailing Address - Phone:229-227-1938
Mailing Address - Fax:
Practice Address - Street 1:15328 US HIGHWAY 19 S
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31757-4824
Practice Address - Country:US
Practice Address - Phone:229-227-1938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1799156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician