Provider Demographics
NPI:1871616730
Name:VITKIN, ELVINA (MD)
Entity type:Individual
Prefix:DR
First Name:ELVINA
Middle Name:
Last Name:VITKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8210 SULLIVAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-3136
Mailing Address - Country:US
Mailing Address - Phone:770-671-9771
Mailing Address - Fax:770-664-0803
Practice Address - Street 1:1080 CAMBRIDGE SQ
Practice Address - Street 2:SUITE B
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-1878
Practice Address - Country:US
Practice Address - Phone:770-664-0803
Practice Address - Fax:770-664-0803
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20292208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAB38147Medicare UPIN