Individual
ELIZA JOHNSON BACOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
600 CELEBRATE LIFE PKWY, NEWNAN, GA 30265-8001
(678) 907-2999
Mailing address
600 CELEBRATE LIFE PKWY, NEWNAN, GA 30265-8001
(678) 907-2999
Taxonomy
Speciality
Code
Description
License number
State
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
RN168366
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220573126A
—
GA
Enumeration date
02/05/2008
Last updated
11/17/2014
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