Provider Demographics
NPI:1730158593
Name:LLEWELLYN, ELIZABETH MARIA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARIA
Last Name:LLEWELLYN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2743 BROOKGROVE CT SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5329
Mailing Address - Country:US
Mailing Address - Phone:404-352-3233
Mailing Address - Fax:770-988-0563
Practice Address - Street 1:2743 BROOKGROVE CT SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5329
Practice Address - Country:US
Practice Address - Phone:404-352-3233
Practice Address - Fax:770-988-0563
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA03585363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP28142Medicare ID - Type Unspecified