Provider Demographics
NPI:1245300524
Name:BANKS, ELIZABETH ANNE (DC)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:BANKS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 LOG CABIN DR SE STE 107
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6742
Mailing Address - Country:US
Mailing Address - Phone:678-239-4864
Mailing Address - Fax:678-239-2531
Practice Address - Street 1:2325 LOG CABIN DR SE STE 107
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-6742
Practice Address - Country:US
Practice Address - Phone:678-239-4864
Practice Address - Fax:678-239-2531
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGNVMedicare ID - Type Unspecified
GAU73814Medicare UPIN