Basic Information
| Provider Information | |||||||||
| NPI: | 1396130340 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELDER | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | CRON | ||||||||
| OtherFirstName: | COURTNEY | ||||||||
| OtherMiddleName: | C | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 49 JESSE HILL JR DR SE | ||||||||
| Address2: | 480A | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303033049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042518796 | ||||||||
| FaxNumber: | 4042518680 | ||||||||
| Practice Location | |||||||||
| Address1: | 49 JESSE HILL JR DR SE | ||||||||
| Address2: | 480A | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303033049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042518796 | ||||||||
| FaxNumber: | 4042518680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2015 | ||||||||
| LastUpdateDate: | 09/26/2019 | ||||||||
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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 | 390200000X | GA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | 82414 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.