Individual provider Active NPI

Elizabeth Anne Eaton, APRN, CPNP

  • Pediatric Nurse Practitioner
  • Atlanta, GA
National Provider Identifier
1073094918
Registry record updated Sep 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
331074 Issued in GA
Practice address
1405 Clifton Rd NE
Atlanta, GA 30322-3491
Phone
(404) 785-7174
NPI assigned
Aug 28, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 331074 GA Primary

Addresses

Primary practice location

1405 Clifton Rd NE
Atlanta, GA 30322-3491

Mailing address

1405 Clifton Rd NE
Atlanta, GA 30322-1060
Phone (404) 785-7174

Other identifiers 1

IdentifierTypeStateIssuer
465641382MedicaidOK

Other names 1

  • Elizabeth Anne Bolen Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241203004670 GA Practitioner - Nurse Practitioner 1052781515 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of South Florida College of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Choa Multispecialty, LLCGroup PAC ID 7719126820, 35 clinicians

Practice addresses (Care Compare)

2174 N Druid Hills Rd NE
Atlanta, GA 30329-3102
Phone (404) 785-5437

Hospital & facility affiliations

  • Athur M Blank Hospital Hospital, Atlanta, GA, CCN 113300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
331074GAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Egleston Pediatric Group Pediatrics Current Accepting new patients
Choa Multispecialty, LLC Pediatrics CurrentSince Oct 1, 2024 Accepting new patients
Choa Hospital Based, LLC Pediatrics Current Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Locations

1405 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 785-1112

2174 N Druid Hills Rd NE
Brookhaven, GA 30329
Phone (404) 785-7856

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1535414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1073094918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 CLIFTON RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303221060",
            "telephone_number": "404-785-7174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 CLIFTON RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303223491",
            "telephone_number": "404-785-7174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EATON",
        "first_name": "ELIZABETH",
        "middle_name": "ANNE",
        "credential": "APRN, CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-28",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "GA",
            "license": "331074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "465641382",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "BOLEN",
            "middle_name": "ANNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.