Provider Demographics
NPI:1871556407
Name:KILGORE, ELIZABETH K (NP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:K
Last Name:KILGORE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:2727 PACES FERRY RD SE STE 1-1100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6151
Mailing Address - Country:US
Mailing Address - Phone:706-353-8700
Mailing Address - Fax:706-353-6629
Practice Address - Street 1:120 HAWTHORNE PARK
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-353-5870
Practice Address - Fax:706-353-6629
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN057459NP363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
50BBCLPMedicare ID - Type Unspecified
S62844Medicare UPIN