Individual
MRS. ELISABETH JACKSON GAINES I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4586 TIMBER RIDGE DR STE 200, DOUGLASVILLE, GA 30135-7514
(770) 942-0457
(770) 942-7699
Mailing address
1835 SAVOY DR, SUITE 300, ATLANTA, GA 30341-1072
(770) 942-0457
(770) 942-7699
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003791
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003101476B
—
GA
01
—
202I970546
MEDICARE PTAN
GA
Enumeration date
11/07/2005
Last updated
12/07/2020
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us