Organization
ESRPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELISSA STANTON (PROVIDER)
(770) 689-8936
Entity
Organization
Contact information
Practice address
1717 BENHILL DR, SNELLVILLE, GA 30078-2595
(770) 689-8936
Mailing address
1717 BENHILL DR, SNELLVILLE, GA 30078-2595
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
10/24/2020
Last updated
12/22/2020
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