Basic Information
| Provider Information | |||||||||
| NPI: | 1164440558 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMERS | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 GREENRIDGE WAY | ||||||||
| Address2: | |||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302654111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706839168 | ||||||||
| FaxNumber: | 7706839618 | ||||||||
| Practice Location | |||||||||
| Address1: | 7050 GALL BLVD | ||||||||
| Address2: | |||||||||
| City: | ZEPHYRHILLS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335411347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137836111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 05/12/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | OS0004829 | FL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 272617300 | 05 | FL | MEDICAID |