Provider Demographics
NPI:1447722558
Name:ELLIOTT, CASEY JAMES (PA)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:JAMES
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:747 OAKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1121
Mailing Address - Country:US
Mailing Address - Phone:423-298-4678
Mailing Address - Fax:
Practice Address - Street 1:747 OAKWOOD ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1121
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant