Provider Demographics
NPI:1912068818
Name:BRUNER, ELIZABETH SHOTTS (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SHOTTS
Last Name:BRUNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 LEWIS FAMILY ROAD
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:GA
Mailing Address - Zip Code:30817
Mailing Address - Country:US
Mailing Address - Phone:706-359-6068
Mailing Address - Fax:706-359-6069
Practice Address - Street 1:EISENHOWER ARMY MEDICAL CENTER
Practice Address - Street 2:BLDG 300 HOSPITAL WAY
Practice Address - City:FT. GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905
Practice Address - Country:US
Practice Address - Phone:706-787-2131
Practice Address - Fax:706-787-2123
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054490171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider