Avery Louise Elloway, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

11573 Issued in GA

Practice address

2750 Owens Rd SW
Conyers, GA 30094-3991

Phone

(678) 413-4644

NPI assigned

Sep 20, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• The Womens Center PC

  • Gynecology Physician
  • Conyers, GA
  • NPI 1871654624
  Medicare reassignment

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

{
    "created_epoch": "1632096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1194495176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 OWENS RD SW",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300943991",
            "telephone_number": "678-413-4644",
            "fax_number": "470-705-0074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 OWENS RD SW",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300943991",
            "telephone_number": "678-413-4644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLOWAY",
        "first_name": "AVERY",
        "middle_name": "LOUISE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-20",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "11573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caroline Ellis
• Selina Y Ellis
• Sherenda Lashawn Ellis
• Howard Steven Ellison, MD
• Margaret Gibson Ellison, EDS, LPC, MAC, CAS
• Michelle Emerson
• Roselande Emmanuel, NP
• Lkeshia Cherie Endsley, FNP-C
• Enhanced Medical Transport
• Keyanna Ennis

• Medical Physician Assistant in Conyers, GA
• Providers in Conyers, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.