Mireille F Ellis, PA

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

001471 Issued in GA

Practice address

2650 Holcomb Bridge Rd Ste 510
Alpharetta, GA 30022-5374

Phone

(404) 255-4080

NPI assigned

Apr 3, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Mimi Ellis Nutrition and Health Coaching, LLC

  • Registered Dietitian
  • Buford, GA
  • NPI 1588353106

  Dietitian, Registered

  NPD Authorized official
• Northlake Anesthesia Professionals, LLC

  • Anesthesiology Physician
  • Atlanta, GA
  • NPI 1982637419
  NPD (past)
• Affiliated Southwest Surgeons PC

  • Surgery Physician
  • Glendale, AZ
  • NPI 1053418327
  NPD (past)
• Bradley K Becker, PC

  • Plastic and Reconstructive Surgery Physician
  • Glendale, AZ
  • NPI 1255519260
  NPD (past)

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681862400000",
    "number": "1154442200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5835 LENOX PARK PL",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305187690",
            "telephone_number": "602-684-4682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 HOLCOMB BRIDGE RD STE 510",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300225374",
            "telephone_number": "404-255-4080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MIREILLE",
        "middle_name": "F",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-03",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "6652",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "GA",
            "license": "001471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Elliott
• Nicole Elliott, LPC
• Shana G Elliott, DDS
• Bryana Ellis, RBT
• Keisha Bonhomme Ellis, MD
• Elliston LLC
• Anna Choo Elmers, M.D.
• Carol Elaine Elmore, PT
• Abbey Marie Elson, DMD
• Dianne Olson Ely, M.S., CCC-SLP

• All providers in Alpharetta, GA
• Registered Dietitian in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; 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.