Provider Demographics
NPI:1063572253
Name:ELLIOTT, PAULA K (DC)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:K
Last Name:ELLIOTT
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 1:1675 HERAEUS BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3383
Mailing Address - Country:US
Mailing Address - Phone:770-271-8382
Mailing Address - Fax:770-932-1277
Practice Address - Street 1:1675 HERAEUS BLVD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3383
Practice Address - Country:US
Practice Address - Phone:770-271-8382
Practice Address - Fax:770-932-1277
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR004685111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6191Medicare ID - Type Unspecified
GAU19475Medicare UPIN