Individual provider Active NPI

Kelli Sharpton

  • Family Nurse Practitioner
  • Vidalia, GA
National Provider Identifier
1316609597
Registry record updated Oct 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN227409 Issued in GA
Practice address
303 Harris Industrial Blvd Ste 3
Vidalia, GA 30474-8854
Phone
(912) 537-9355
NPI assigned
Oct 6, 2021
Last updated
Oct 6, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN227409 GA Primary

Addresses

Primary practice location

303 Harris Industrial Blvd Ste 3
Vidalia, GA 30474-8854

Mailing address

300 Jay LN
Mount Vernon, GA 30445-3359

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250710002492 GA Practitioner - Nurse Practitioner 1557875457 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Primary Care of Georgia LLCGroup PAC ID 0648421065, 20 clinicians

Practice addresses (Care Compare)

1005 Boulder Dr
Gray, GA 31032-6141
Phone (478) 621-2100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN227409GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Optimus Diagnostics LLC Current Accepting new patients
Community Primary Care of Georgia LLC CurrentSince Mar 20, 2025 Accepting new patients

Locations

1005 Boulder Dr
Gray, GA 31032
Phone (478) 621-2072

300 Cedar St
Metter, GA 30439
Phone (912) 685-5703

405 S College St
Statesboro, GA 30458
Phone (912) 764-4575

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1633478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633478400000",
    "number": "1316609597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 JAY LN",
            "city": "MOUNT VERNON",
            "state": "GA",
            "postal_code": "304453359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 HARRIS INDUSTRIAL BLVD STE 3",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304748854",
            "telephone_number": "912-537-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHARPTON",
        "first_name": "KELLI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-06",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN227409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vidalia, GA

Sources for this page

Verify at the official NPI Registry.