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Organization

MARK P. ELAM, M.D., P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DENNIS STOUT (ADMINISTRATOR)
(706) 226-4642
Entity
Organization

Contact information

Practice address
1115 PROFESSIONAL BLVD, DALTON, GA 30720-2628
(706) 226-4642
Mailing address
1575 CHATTANOOGA AVE, SUITE 2, DALTON, GA 30720-2671
(706) 876-2186

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
036417
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000546532D
GA
Enumeration date
05/04/2012
Last updated
05/04/2012
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