Provider Demographics
NPI:1053036277
Name:ELGINDALE PARTNERS, LLC
Entity type:Organization
Organization Name:ELGINDALE PARTNERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ELGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-769-7990
Mailing Address - Street 1:1100 MOSSPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4163
Mailing Address - Country:US
Mailing Address - Phone:404-769-7990
Mailing Address - Fax:
Practice Address - Street 1:1000 JOHNSON FERRY RD STE E150
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2176
Practice Address - Country:US
Practice Address - Phone:404-769-7990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty