Individual
MARISA ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1430 JOHN WESLEY GILBERT DRIVE, AUGUSTA, GA 30912-0001
(706) 721-2441
Mailing address
1430 JOHN WESLEY GILBERT DRIVE, AUGUSTA, GA 30912-0001
(706) 721-2441
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
DN123146
GA
Other
Enumeration date
03/08/2023
Last updated
12/16/2023
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