NPIMap

Organization Active NPI

KCP Enterprises

  • Physical Medicine & Rehabilitation Physician
  • Morrow, GA
National Provider Identifier
1043679418
Registry record updated Dec 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
KCP ENTERPRISES
Practice address
1568 Southlake Pkwy Ste C
Morrow, GA 30260
Phone
(470) 878-0696
NPI assigned
Feb 15, 2016
Organization subpart
Yes
Parent organization
KCP ENTERPRISESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Emma C Cull
Title
Coo
Phone
(678) 469-5011

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X Primary
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

1568 Southlake Pkwy Ste C
Morrow, GA 30260

Mailing address

1568 Southlake Pkwy Ste C
Morrow, GA 30260-4153
Phone (470) 878-0696

Other practice location 1

5505 Peachtree Dunwoody Rd Ste 370
Sandy Springs, GA 30342-1713
Phone (770) 961-6222

Other names 2

  • Elite Medical and Rehab Doing business as
  • Elite Rehab and Weightloss Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240312001492 GA Part B Supplier - Clinic/Group Practice 7517303613 Receives reassigned benefits from 6 practitioners
Practice locations: Atlanta, GA; Morrow, GA; Woodstock, GA

National Provider Directory

National Provider Directory
Tax ID family
KCP Enterprises LLC3 organizations share this tax ID, including this one
Part of
KCP Enterprises LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1568 Southlake Pkwy
Ste C
Morrow, GA 30260
Phone (470) 878-0696

203 Woodpark Pl
Ste 102
Woodstock, GA 30188
Phone (678) 748-3343

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1455494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765238400000",
    "number": "1043679418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1568 SOUTHLAKE PKWY STE C",
            "city": "MORROW",
            "state": "GA",
            "postal_code": "302604153",
            "telephone_number": "470-878-0696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1568 SOUTHLAKE PKWY STE C",
            "city": "MORROW",
            "state": "GA",
            "postal_code": "30260",
            "telephone_number": "470-878-0696"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5505 Peachtree Dunwoody Rd Ste 370",
            "address_purpose": "LOCATION",
            "city": "Sandy Springs",
            "state": "GA",
            "postal_code": "303421713",
            "country_code": "US",
            "telephone_number": "770-961-6222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KCP ENTERPRISES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KCP ENTERPRISES",
        "enumeration_date": "2016-02-15",
        "last_updated": "2025-12-09",
        "certification_date": "2025-12-09",
        "status": "A",
        "authorized_official_last_name": "CULL",
        "authorized_official_first_name": "EMMA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "678-469-5011"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elite Medical and Rehab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Elite Rehab and Weightloss",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Morrow, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.