Organization
ELISIVE QUALITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ISMAEL SUARES MEDINA (CEO)
(404) 580-1041
Entity
Organization
Contact information
Practice address
925B PEACHTREE ST NE # 131, ATLANTA, GA 30309-3918
(404) 580-1041
Mailing address
925B PEACHTREE ST NE # 131, ATLANTA, GA 30309-3918
(404) 580-1041
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
09/15/2008
Last updated
10/16/2008
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