Provider Demographics
NPI:1982475992
Name:ELIZABETH FUQUA LLC
Entity type:Organization
Organization Name:ELIZABETH FUQUA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FUQUA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:410-459-1508
Mailing Address - Street 1:8342 GREENOCK DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3234
Mailing Address - Country:US
Mailing Address - Phone:410-459-1508
Mailing Address - Fax:
Practice Address - Street 1:5318 PATTERSON AVE STE E
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2044
Practice Address - Country:US
Practice Address - Phone:804-489-8758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty