Individual
ELISSA GLORIA FONTENOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2801 DEKALB MEDICAL PKWY, LITHONIA, GA 30058-4996
(404) 501-8000
Mailing address
105 PRINCETON CT, COVINGTON, GA 30016-2953
(678) 793-3123
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
RN241909
GA
363L00000X
Nurse Practitioner
Primary
NCO-000003
GA
Other
Enumeration date
03/16/2021
Last updated
03/16/2021
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