Provider Demographics
NPI:1386156503
Name:DRUSKY, ELISA (PA-C)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:DRUSKY
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 1:711 CANTON RD NE STE 300
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8949
Mailing Address - Country:US
Mailing Address - Phone:678-741-5000
Mailing Address - Fax:678-819-4280
Practice Address - Street 1:711 CANTON RD NE STE 300
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8949
Practice Address - Country:US
Practice Address - Phone:678-741-5000
Practice Address - Fax:678-819-4280
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005234RX363AM0700X
GA9189363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical