Provider Demographics
NPI:1437107513
Name:MCELHANNON, FAYETTE MONROE JR (MD)
Entity type:Individual
Prefix:
First Name:FAYETTE
Middle Name:MONROE
Last Name:MCELHANNON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1000 HAWTHORNE AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2168
Mailing Address - Country:US
Mailing Address - Phone:706-548-1386
Mailing Address - Fax:706-369-1903
Practice Address - Street 1:1000 HAWTHORNE AVE
Practice Address - Street 2:SUITE J
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2168
Practice Address - Country:US
Practice Address - Phone:706-548-1386
Practice Address - Fax:706-369-1903
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA011977207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD46078Medicare UPIN