Individual provider Active NPI

Elijah Long, DPT

  • Physical Therapist
  • Augusta, GA
National Provider Identifier
1104554195
Registry record updated Aug 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT016046 Issued in GA
Practice address
254 Robert C Daniel Jr Pkwy Ste 4B
Augusta, GA 30909-0812
Phone
(706) 723-5795
NPI assigned
Aug 9, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT016046 GA Primary

Addresses

Primary practice location

254 Robert C Daniel Jr Pkwy Ste 4B
Augusta, GA 30909-0812

Mailing address

1200 Corporate Dr Ste 400
Hoover, AL 35242-5424
Phone (423) 541-3263

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220824003575 GA Practitioner - Physical Therapist in Private Practice 9436533445 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Independent Physical Therapy of Georgia, LLCGroup PAC ID 2961312244, 526 clinicians

Practice addresses (Care Compare)

254 Robert C Daniel Jr Pkwy
Suite 4B
Augusta, GA 30909-0812
Phone (706) 723-5795

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT016046GAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Agilitas USA Inc Physical Therapist CurrentSince Sep 4, 2025 Accepting new patients
Atlanta South Physical Therapy, Inc Physical Therapist CurrentSince Aug 9, 2022 Accepting new patients
Agilitas USA, Inc Physical Therapist CurrentSince Sep 4, 2025 Accepting new patients
Drayer Physical Therapy Georgia LLC Physical Therapist CurrentSince Aug 9, 2022 Accepting new patients
Independent Physical Therapy of Georgia, LLC Physical Therapist CurrentSince Aug 9, 2022 Accepting new patients
Benchmark Physical Therapy, Inc CurrentSince Aug 9, 2022 Accepting new patients
Independent Physical Therapy of Georgia, LLC Physical Therapist CurrentSince Aug 9, 2022 Accepting new patients

Locations

1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568

12850 Highway 9 N
Ste 1050
Alpharetta, GA 30004
Phone (678) 332-5800

254 Robert C Daniel Jr Pkwy
Ste 4B
Augusta, GA 30909
Phone (706) 723-5795

1025 E West Connector
Ste 406
Austell, GA 30106
Phone (770) 384-1001

7130 Mount Zion Blvd
Ste 9
Jonesboro, GA 30236
Phone (770) 603-5660

3455 Highway 81
Loganville, GA 30052
Phone (678) 635-8280

11490 Alpharetta Hwy
Ste 200
Roswell, GA 30076
Phone (770) 740-8592

6397 Lee Hwy
Ste 300
Chattanooga, TN 37421
Phone (423) 238-8923

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1660003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660003200000",
    "number": "1104554195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CORPORATE DR STE 400",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352425424",
            "telephone_number": "423-541-3263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "254 ROBERT C DANIEL JR PKWY STE 4B",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309090812",
            "telephone_number": "706-723-5795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "ELIJAH",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-09",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT016046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.