Jumpstart Fitness Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT001550 Issued in GA

Legal business name

JUMPSTART FITNESS INC

Practice address

60 Old Highway 5 S
Ellijay, GA 30540-5436

Phone

(170) 627-6200

Fax

(706) 276-2080

NPI assigned

Apr 10, 2007

Organization subpart

No

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

Authorized official

Name

Melonie Clemmons, O.D.NPI 1609099530

Title

President

Phone

(706) 276-2000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ellijay Eye Care Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Melonie Clemmons, O.D.

  • Optometrist
  • Ellijay, GA
  • NPI 1609099530
  Medicare reassignment Care Compare group NPD Authorized official
• Maria Jean Nelsen, O.D.

  • Optometrist
  • Ellijay, GA
  • NPI 1649386608
  Medicare reassignment Care Compare group NPD
• Joel P. Yagoda, O.D.

  • Optometrist
  • Cartersville, GA
  • NPI 1205974946
  Medicare reassignment NPD

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629763200000",
    "number": "1194948034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 146",
            "city": "EAST ELLIJAY",
            "state": "GA",
            "postal_code": "305390003",
            "telephone_number": "706-276-2000",
            "fax_number": "706-276-2080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 OLD HIGHWAY 5 S",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305405436",
            "telephone_number": "170-627-6200",
            "fax_number": "706-276-2080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUMPSTART FITNESS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2021-08-24",
        "certification_date": "2021-08-24",
        "status": "A",
        "authorized_official_last_name": "CLEMMONS",
        "authorized_official_first_name": "MELONIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-276-2000",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT001550",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "910061011A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellijay Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maryanne Ingram, OTR/L
• JD Medical Services Inc
• Kimberly Erin Johnson, MSPT
• James Michael Jones, PT
• Tina Jones, LPC013310
• Kathy Romanick Licensed Clinical Social Worker an LLC
• Cheryl M. Keats, LCSW
• Kelvin Moss MD PC
• Alana Maria Kent, MD
• Kathy Lynn Kinnison, P.T.

• Optometrist in Ellijay, GA
• Providers in Ellijay, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.