Keelia Elise Benner, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10675 Issued in GA

Practice address

6002 Professional Pkwy Ste 140
Douglasville, GA 30134-5603

Phone

(678) 715-9690

NPI assigned

Apr 24, 2021

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

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

Specialty

Physician Assistant

Education

Philadelphia College of Osteopathic Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Peachtree Immediate Care FP, LLCGroup PAC ID 3274559323, 328 clinicians

Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

93.93 of 100Reported as apm

Quality

82.14

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Peachtree Immediate Care FP, LLC

  • Family Medicine Physician
  • Hiram, GA
  • NPI 1437194156
  Medicare reassignment Care Compare group
• Wellstar Medical Group, LLC

  dba WellStar Family Medicine ACW

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment Care Compare group
• The Bortolazzo Group, LLC

  • Emergency Medicine Physician
  • Austell, GA
  • NPI 1801965082
  Medicare reassignment
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD
• Wellstar Cardiovascular Medicine, LLC

  • Cardiovascular Disease Physician
  • Marietta, GA
  • NPI 1457320319
  NPD (past)

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

{
    "created_epoch": "1619222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770422400000",
    "number": "1295317766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 OLD PEACHTREE RD NW",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300242937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6002 PROFESSIONAL PKWY STE 140",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301345603",
            "telephone_number": "678-715-9690"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "625 Old Peachtree Rd NW",
            "address_purpose": "LOCATION",
            "city": "Suwanee",
            "state": "GA",
            "postal_code": "300242937",
            "country_code": "US",
            "telephone_number": "678-225-7500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8954 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Douglasville",
            "state": "GA",
            "postal_code": "301342272",
            "country_code": "US",
            "telephone_number": "770-874-5400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BENNER",
        "first_name": "KEELIA",
        "middle_name": "ELISE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-24",
        "last_updated": "2026-02-07",
        "certification_date": "2026-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "10675",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taijah Bell, LCSW
• Bellam Enterprises Inc. (Better off at Home)
• Olufunmilola Ruth Bello, MS
• Ryan Wayne Belmore, PT
• Samanta M Benjamin
• Adriana Bennett, RBT
• Adia Benson
• Kristopher Glen Bernarde
• Dwainie Berry, RBT
• Isabelle Nicole Betances

• Physician Assistant in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2026; 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.
• 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.