Provider Demographics
NPI:1982163846
Name:ELAM, JACOB MARSHALL (MD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:MARSHALL
Last Name:ELAM
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 1:2415 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4722
Mailing Address - Country:US
Mailing Address - Phone:912-261-0447
Mailing Address - Fax:912-261-1847
Practice Address - Street 1:2500 STARLING ST STE 602
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4271
Practice Address - Country:US
Practice Address - Phone:912-466-4669
Practice Address - Fax:912-265-3580
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA100779208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology