Individual provider Active NPI

Suzanne Ivie Ellis

  • Speech-Language Pathologist
  • Smyrna, GA
National Provider Identifier
1194565978
Registry record updated May 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
4005 S Cobb Dr SE
Smyrna, GA 30080-6307
Phone
(770) 431-7055
NPI assigned
May 29, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X GA Primary

Addresses

Primary practice location

4005 S Cobb Dr SE
Smyrna, GA 30080-6307

Mailing address

4005 S Cobb Dr SE
Smyrna, GA 30080-6307

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251023003404 GA Practitioner - Qualified Speech Language Pathologist 4981192648 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Healthcare Services Inc Multi-Specialty CurrentSince Sep 1, 2025 Accepting new patients
Legacy Healthcare Services, Inc. Multi-Specialty CurrentSince Sep 1, 2025 Accepting new patients
Legacy Healthcare Services, Inc. Multi-Specialty CurrentSince Sep 1, 2025 Accepting new patients

Locations

3333 E Cherokee Dr
Canton, GA 30115
Phone (470) 714-6698

110 Horizon Dr
Ste 310
Raleigh, NC 27615
Phone (970) 215-3300

Organizations & group practices 15

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.

View all 15

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Healthcare Services Inc 3,431 clinicians
Reliant Senior Living LLC 117 clinicians

Practice addresses (Care Compare)

100 Whitlock Ave NW
Marietta, GA 30064-2362
Phone (678) 919-7114

4005 S Cobb Dr
Smyrna, GA 30008
Phone (678) 239-4777

5844 Lawrenceville Hwy
Tucker, GA 30084-1930
Phone (770) 398-4195

NPI Registry JSON

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

{
    "created_epoch": "1716940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716940800000",
    "number": "1194565978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4005 S COBB DR SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300806307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4005 S COBB DR SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300806307",
            "telephone_number": "770-431-7055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "SUZANNE",
        "middle_name": "IVIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-05-29",
        "last_updated": "2024-05-29",
        "certification_date": "2024-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Smyrna, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2024; 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.