Provider Demographics
NPI:1902980246
Name:ELWELL, KIRSTY J (PA-C)
Entity Type:Individual
Prefix:
First Name:KIRSTY
Middle Name:J
Last Name:ELWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2001 ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-4622
Mailing Address - Country:US
Mailing Address - Phone:706-275-7600
Mailing Address - Fax:706-275-0013
Practice Address - Street 1:2001 ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-4622
Practice Address - Country:US
Practice Address - Phone:706-275-7600
Practice Address - Fax:706-275-0013
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA4447363AM0700X
TN1519363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical