Gaines, Elisabeth Jackson

Gaines, Elisabeth Jackson is an individual health care provider with primary practice located at 4586 Timber Ridge Dr Ste 200 , Douglasville GA 30135-7514. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Gaines, Elisabeth Jackson can be contacted via phone (770) 942-0457.

Contact Information

Primary practice address
4586 Timber Ridge Dr Ste 200 Douglasville GA 30135-7514
Phone: (770) 942-0457
Fax: (770) 942-7699
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 003791 Georgia

Profile Details

NPI number 1194706234
LBN Legal business name Gaines, Elisabeth Jackson
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 7th, 2005
Last updated Dec 7th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194706234 NPPES
Georgia MEDICAID 003101476B
Georgia Other 202I970546

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