Provider Demographics
NPI:1285513127
Name:ELLIOTT, JACOB CORBIT (PHARMD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:CORBIT
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3839 MUNDY MILL RD
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-3415
Mailing Address - Country:US
Mailing Address - Phone:770-532-5772
Mailing Address - Fax:770-532-5828
Practice Address - Street 1:3839 MUNDY MILL RD
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-3415
Practice Address - Country:US
Practice Address - Phone:770-532-5772
Practice Address - Fax:770-532-5828
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH035779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist