Elizabeth Myrna Ellis, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

521 Issued in GA

Practice address

801 Amsterdam Ave NE
Atlanta, GA 30306-3403

Phone

(770) 337-9446

Fax

(770) 476-0377

NPI assigned

Jan 3, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Chante Wellington Mitchell, PH.D., LLC

  • Clinical Psychologist
  • Duluth, GA
  • NPI 1831865674
  NPD (past)

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1053478503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 AMSTERDAM AVE NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303063403",
            "telephone_number": "770-337-9446",
            "fax_number": "770-476-0377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 AMSTERDAM AVE NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303063403",
            "telephone_number": "770-337-9446",
            "fax_number": "770-476-0377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "ELIZABETH",
        "middle_name": "MYRNA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-03",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00196171B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Claudia Ellis
• Colter Ellis, RD
• Deandrea Ellis
• Donovan Ellis, PHD
• Dorian Ellis
• Hayley Ellis, LCSW
• Jane E Ellis, MD
• Janine Ellis
• Joeann Renee' Ellis, PT
• Kelly S Ellis, ATC, LAT, PTA

• Clinical Psychologist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Clinical Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.