Active NPI
Ellion Profitt
- Prosthetics Case Management
- Stone Mountain, GA
National Provider Identifier
1366942047
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetics Case Management
- License
- CO101834
- Practice address
- 5479 Memorial Dr Ste 2
Stone Mountain, GA 30083-3247 - Phone
- (678) 431-6352
- NPI assigned
- Feb 19, 2018
- 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 |
|---|---|---|---|---|
| Prosthetics Case Management | 1744P3200X | CO101834 | GA | Primary |
Addresses
Primary practice location
5479 Memorial Dr Ste 2
Stone Mountain, GA 30083-3247
Mailing address
3738 Waldrop Creek CT
Decatur, GA 30034-6723
Phone (678) 431-6352
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CO101834 | Other | GA | SECRETARY OF STATE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CO101834 | GA | MD | Prosthetics Case Management |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1518998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1518998400000",
"number": "1366942047",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3738 WALDROP CREEK CT",
"city": "DECATUR",
"state": "GA",
"postal_code": "300346723",
"telephone_number": "678-431-6352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5479 MEMORIAL DR STE 2",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300833247",
"telephone_number": "678-431-6352"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROFITT",
"first_name": "ELLION",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-02-19",
"last_updated": "2018-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "1744P3200X",
"taxonomy_group": "",
"desc": "Specialist, Prosthetics Case Management",
"state": "GA",
"license": "CO101834",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SECRETARY OF STATE",
"identifier": "CO101834",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stone Mountain, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.