Provider Demographics
NPI:1962411207
Name:ROYSTON, ELLIOT PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:PAUL
Last Name:ROYSTON
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 1:2785 LAWRENCEVILLE HWY STE 210
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2515
Mailing Address - Country:US
Mailing Address - Phone:770-939-5130
Mailing Address - Fax:770-908-8619
Practice Address - Street 1:2785 LAWRENCEVILLE HWY STE 210
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2515
Practice Address - Country:US
Practice Address - Phone:770-939-5130
Practice Address - Fax:770-908-8619
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039454207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF32462Medicare UPIN
GAGRP5119Medicare ID - Type Unspecified