Provider Demographics
NPI:1306102785
Name:GOLAN, ELAN J (MD)
Entity type:Individual
Prefix:MR
First Name:ELAN
Middle Name:J
Last Name:GOLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 WISTERIA DR STE 202
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-4604
Mailing Address - Country:US
Mailing Address - Phone:678-344-4944
Mailing Address - Fax:
Practice Address - Street 1:2220 WISTERIA DR STE 202
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-4604
Practice Address - Country:US
Practice Address - Phone:678-344-4944
Practice Address - Fax:678-344-4947
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA83600207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program