Provider Demographics
NPI:1912991464
Name:RAMBO, ELIZABETH P (PA-C)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:P
Last Name:RAMBO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:RAMBO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:531 ROSELANE ST NW STE 710
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6975
Mailing Address - Country:US
Mailing Address - Phone:678-331-3297
Mailing Address - Fax:678-581-7187
Practice Address - Street 1:1700 HOSPITAL SOUTH DR STE 300
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8116
Practice Address - Country:US
Practice Address - Phone:770-944-2830
Practice Address - Fax:678-581-7170
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004250363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1912991464OtherNPI NUMBER
GA97WCGGJMedicare ID - Type Unspecified