Carl Edward Ellis Jr.

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

RPH009402 Issued in GA

Practice address

700 City Hall Dr
Fort Oglethorpe, GA 30742-7802

Phone

(706) 861-3387

Fax

(706) 861-3332

NPI assigned

Mar 19, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Carl Ellis Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Lookout Mountain Community Services

  • Community/Behavioral Health Agency
  • Fort Oglethorpe, GA
  • NPI 1568599090
  NPD (past)

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376667105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 S GLADE RD",
            "city": "FORT OGLETHORPE",
            "state": "GA",
            "postal_code": "307423909",
            "telephone_number": "706-866-5097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 CITY HALL DR",
            "city": "FORT OGLETHORPE",
            "state": "GA",
            "postal_code": "307427802",
            "telephone_number": "706-861-3387",
            "fax_number": "706-861-3332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "CARL",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "GA",
            "license": "RPH009402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARL",
            "last_name": "ELLIS",
            "credential": "RPH",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Lindsey Dowdle, DPT
• Sarah Drake, OTR/L
• Shari Driscoll, PTA
• Regina Michelle Durham, COTA/L
• Edwin T Hulse MD,PC
• Crystal Danielle Elsberry, LPN
• Mary Christina Emery, PTA
• Erdman ENT, PC
• John P. Erdman, MD
• Essential Dental, Inc. (Essential Dental)

• Mental Health Clinic/Center (Including Community Mental Health Center) in Fort Oglethorpe, GA
• Providers in Fort Oglethorpe, GA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.