Stephen Thomas Ellis
Individual provider Active NPI Physician Assistant · Holly Springs, GA
NPI 1013733575 · NPPES record last updated Dec 2, 2024
Key facts
- NPI
- 1013733575
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 100 Holly Park CT Apt 6308
Holly Springs, GA 30115-0226 - Phone
- (770) 380-2334
- NPI assigned
- Dec 2, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2025
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
2201 Henderson Mill Rd NE
Atlanta, GA 30345-2711
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260508000844 | GA | Practitioner - Physician Assistant | 3173091014 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
100 Holly Park CT Apt 6308
Holly Springs, GA 30115-0226
Mailing address
100 Holly Park CT Apt 6308
Holly Springs, GA 30115-0226
Phone (770) 380-2334
Other providers in Holly Springs, GA
- Dotson Stevens Enterprises, Inc.
- Andrew Edward Doyle
- Dr. Tom LLC
- Anuj Kumar Dua
- Cynthia Elizabeth Duprey
- Embrace Mobility Therapy Services
- Oliver Raymond Evans II
- Jillian Ferdinand
- Jazzmin Gastley
- Georgia Chiropractic and Massage, PC
All providers in Holly Springs, GA · Physician Assistant in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.