Basic Information
| Provider Information | |||||||||
| NPI: | 1386642072 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARMER | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | |||||||||
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| Credential: | PT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 MEDICAL DR NE | ||||||||
| Address2: | |||||||||
| City: | CARTERSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301218005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703865221 | ||||||||
| FaxNumber: | 7703861128 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 MEDICAL DR NE | ||||||||
| Address2: | |||||||||
| City: | CARTERSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301218005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703865221 | ||||||||
| FaxNumber: | 7703861128 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 08/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTH3757 | AL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT007601 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 000972254A | 05 | GA | MEDICAID | 000972254G | 05 | GA | MEDICAID | P00320623 | 01 | GA | RR MEDICARE | OTHER |