Ida Ellis, CNA

Key facts

NPI

1134079528

Entity type

Individual (NPI type 1)

Primary specialty

Nurse's Aide 376K00000X

License

CN0030019746 (GA)

Practice address

1874 Sewell Rd
Grantville, GA 30220-2609

Phone

(770) 755-7020

Fax

(770) 755-7020

NPI assigned

Feb 3, 2026

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 3, 2026.

{
    "created_epoch": "1770076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770076800000",
    "number": "1134079528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1874 SEWELL RD",
            "city": "GRANTVILLE",
            "state": "GA",
            "postal_code": "302202609",
            "telephone_number": "770-755-7020",
            "fax_number": "770-755-7020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1874 SEWELL RD",
            "city": "GRANTVILLE",
            "state": "GA",
            "postal_code": "302202609",
            "telephone_number": "770-755-7020",
            "fax_number": "770-755-7020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "IDA",
        "credential": "CNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-02-03",
        "last_updated": "2026-02-03",
        "certification_date": "2026-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "GA",
            "license": "CN0030019746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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