Provider Demographics
NPI:1932851367
Name:ELLIOTT, TERRIS (REEGT, CLTM)
Entity Type:Individual
Prefix:MR
First Name:TERRIS
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:REEGT, CLTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-1937
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:207 NORTH AVE
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1937
Practice Address - Country:US
Practice Address - Phone:770-568-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7353
TN238742084S0012X
GA4992084D0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic Neuroimaging
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine