Provider Demographics
NPI:1255985750
Name:WADSWORTH, ELIZABETH WALKER (MD, MSCR)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:WALKER
Last Name:WADSWORTH
Suffix:
Gender:F
Credentials:MD, MSCR
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:REBECCA
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MSCR
Mailing Address - Street 1:999 WYLIE ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-1301
Mailing Address - Country:US
Mailing Address - Phone:404-376-9330
Mailing Address - Fax:
Practice Address - Street 1:960 JOHNSON FY RD NE STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1601
Practice Address - Country:US
Practice Address - Phone:404-943-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA390200000X
SCLL84440207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program