Basic Information
| Provider Information | |||||||||
| NPI: | 1972755718 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIRKLEY | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | C.N.M. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SUNDAY | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | R | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | C.N.M | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 699 CHURCH ST. NE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300601122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704228700 | ||||||||
| FaxNumber: | 7704257601 | ||||||||
| Practice Location | |||||||||
| Address1: | 699 CHURCH ST. NE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300601122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704228700 | ||||||||
| FaxNumber: | 7704257601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2008 | ||||||||
| LastUpdateDate: | 01/15/2014 | ||||||||
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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 | 367A00000X | RN152838 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 898378846A | 05 | GA | MEDICAID |