Active NPI
Mattie Anita Elam, PHARM.D.
- Pharmacist
- Fort Gordon, GA
National Provider Identifier
1497911788
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH015725
- Practice address
- 300 W Hospital Rd
Eisenhower Army Medical Center
Fort Gordon, GA 30905-5741 - Phone
- (706) 787-2720
- Fax
- (706) 787-8176
- NPI assigned
- Aug 6, 2008
- Last updated
- Aug 6, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH015725 | GA | Primary |
| Pharmacist | 183500000X | T09902 | MS |
Addresses
Primary practice location
300 W Hospital Rd
Eisenhower Army Medical Center
Fort Gordon, GA 30905-5741
Mailing address
300 W Hospital Rd
Eisenhower Army Medical Center
Fort Gordon, GA 30905-5741
Phone (706) 787-2720
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH015725 | GA | MD | Pharmacist |
| T09902 | MS | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217980800000",
"number": "1497911788",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 W HOSPITAL RD",
"address_2": "EISENHOWER ARMY MEDICAL CENTER",
"city": "FORT GORDON",
"state": "GA",
"postal_code": "309055741",
"telephone_number": "706-787-2720",
"fax_number": "706-787-8176"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W HOSPITAL RD",
"address_2": "EISENHOWER ARMY MEDICAL CENTER",
"city": "FORT GORDON",
"state": "GA",
"postal_code": "309055741",
"telephone_number": "706-787-2720",
"fax_number": "706-787-8176"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELAM",
"first_name": "MATTIE",
"middle_name": "ANITA",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-06",
"last_updated": "2008-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH015725",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "T09902",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Gordon, GA
- Eisenhower Army Medical Center (Usadc Ft. Gordon Oral HLTH Ctr)
- Eisenhower Army Medical Center (Usadc Ft. Gordon Snyder)
- Eisenhower Army Medical Center (Connelly Health Clinic)
- Eisenhower Army Medical Center (Usadc Ft. Gordon Tingay)
- Eisenhower Army Medical Center (TMC-4-Ft. Gordon)
- Han Eol Eom, DDS
- Jerel James Erne, MD
- Signe Alexis Erne, PHYSICIAN ASSISTANT
- Marcos Antonio Esquivel Cardoso, DDS
- Kimberly Gardner Evans, PHARM. D
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.