Provider Demographics
NPI:1215168133
Name:VANDEL, ELIZABETH DANNER (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DANNER
Last Name:VANDEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:203 WOODPARK PL
Mailing Address - Street 2:BUILDING C
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3705
Mailing Address - Country:US
Mailing Address - Phone:770-926-4150
Mailing Address - Fax:770-926-0594
Practice Address - Street 1:203 WOODPARK PL
Practice Address - Street 2:BUILDING C
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3705
Practice Address - Country:US
Practice Address - Phone:770-926-4150
Practice Address - Fax:770-926-0594
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA005583363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I972364Medicare PIN