Provider Demographics
NPI:1750574455
Name:MCELROY, CLINTON EDGAR (MD)
Entity type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:EDGAR
Last Name:MCELROY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CLINT
Other - Middle Name:E
Other - Last Name:MCELROY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7401 BLACKMON RD
Mailing Address - Street 2:APT. 3401
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-4489
Mailing Address - Country:US
Mailing Address - Phone:404-574-3365
Mailing Address - Fax:
Practice Address - Street 1:2122 MANCHESTER EXPY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6878
Practice Address - Country:US
Practice Address - Phone:404-574-3364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-26
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA65284207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology