Active NPI
Suzanne Ivie Ellis
- Speech-Language Pathologist
- Smyrna, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 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 ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Legacy Healthcare Services Inc | Multi-Specialty | Current | Accepting new patients |
| Legacy Healthcare Services, Inc. | Multi-Specialty | Current | Accepting new patients |
| Legacy Healthcare Services, Inc. | Multi-Specialty | Current | 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.
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GA, Multi-Specialty
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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 IncReliant Senior Living LLC
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.