Mark P. Elam, M.D., P.C.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

036417 Issued in GA

Legal business name

MARK P. ELAM, M.D., P.C.

Practice address

1115 Professional Blvd
Dalton, GA 30720-2628

Phone

(706) 226-4642

NPI assigned

May 4, 2012

Organization subpart

No

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

Authorized official

Name

Dennis Stout

Title

Administrator

Phone

(706) 226-4642

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Dana Lucas Brewington, DPM

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  NPD (past)

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

{
    "created_epoch": "1336089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336089600000",
    "number": "1104185552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1575 CHATTANOOGA AVE",
            "address_2": "SUITE 2",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307202671",
            "telephone_number": "706-876-2186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 PROFESSIONAL BLVD",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307202628",
            "telephone_number": "706-226-4642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK P. ELAM, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-04",
        "last_updated": "2012-05-04",
        "status": "A",
        "authorized_official_last_name": "STOUT",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "706-226-4642"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "036417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000546532D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Dalton, GA
• Skilled Nursing Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.