Basic Information
Provider Information | |||||||||
NPI: | 1740252428 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHAHINE | ||||||||
FirstName: | ELIZABETH | ||||||||
MiddleName: | BRITTON | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WIMBERLY | ||||||||
OtherFirstName: | ELIZABETH | ||||||||
OtherMiddleName: | BRITTON | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 69 JESSE HILL JR DR SE | ||||||||
Address2: | 4TH FLOOR GLENN BUILDING | ||||||||
City: | ATLANTA | ||||||||
State: | GA | ||||||||
PostalCode: | 303033031 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4047278600 | ||||||||
FaxNumber: | 4045213589 | ||||||||
Practice Location | |||||||||
Address1: | 80 JESSE HILL JR DR SE | ||||||||
Address2: |   | ||||||||
City: | ATLANTA | ||||||||
State: | GA | ||||||||
PostalCode: | 303033031 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4047278600 | ||||||||
FaxNumber: | 4047278609 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/06/2006 | ||||||||
LastUpdateDate: | 07/29/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 042801 | GA | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
ID | Type | State | Issuer | Description | 006213324 | 05 | VA |   | MEDICAID | 033824200 | 05 | DC |   | MEDICAID | 714405900 | 05 | MD |   | MEDICAID |