Basic Information
| Provider Information | |||||||||
| NPI: | 1508437211 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | UNDERWOOD | ||||||||
| FirstName: | ELISABETH | ||||||||
| MiddleName: | AUSTIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 417 SAINT CATHERINES CT NW | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300641430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703617858 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 JOHNSON FY RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048518000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2021 | ||||||||
| LastUpdateDate: | 05/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN249617 | GA | N | Nursing Service Providers | Registered Nurse | 367500000X | 137811 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.