Provider Demographics
NPI:1194157602
Name:DEVEREAUX, ELIZABETH ANN (NP)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:DEVEREAUX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 W PACES FERRY RD NW
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2308
Mailing Address - Country:US
Mailing Address - Phone:404-233-3937
Mailing Address - Fax:404-261-3996
Practice Address - Street 1:1218 W PACES FERRY RD NW
Practice Address - Street 2:SUITE 108
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2308
Practice Address - Country:US
Practice Address - Phone:404-233-3937
Practice Address - Fax:404-261-3996
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAA0713131363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health