Shalonda B Pettis, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

004248 Issued in GA

Practice address

1255 Highway 54 W
Fayetteville, GA 30214-4526

Phone

(404) 367-3014

Fax

(404) 367-3558

NPI assigned

Jan 2, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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

Emory University School of Medicine, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Grady Memorial Hospital CorporationGroup PAC ID 7517032998, 365 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Grady Memorial Hospital Hospital, Atlanta, GA, CCN 110079

Merit-based Incentive Payment System (MIPS)

Final score

96.48 of 100Reported as group

Quality

87.56

Promoting interoperability

100

Improvement activities

40

Cost

75.14

Merit-based Incentive Payment System (MIPS)

Final score

91.62 of 100Reported as apm

Quality

83.25

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shalonda.pettis@755225060900868.direct.elationemr.com

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.

• Grady Memorial Hospital Corporation

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1114243813
  Medicare reassignment Care Compare group NPD
• Piedmont Hospitalist Physicians LLC

  • Family Medicine Physician
  • Stockbridge, GA
  • NPI 1548219660
  Medicare reassignment
• Wellstreet of Georgia PC

  • Urgent Care Clinic/Center
  • Newnan, GA
  • NPI 1235411547
  Medicare reassignment
• Elite Wellness Solutions, LLC

  • Health & Wellness Coach
  • East Point, GA
  • NPI 1780338467
  NPD
• Grady Memorial Hospital Corporation

  • Rehabilitation Hospital
  • Atlanta, GA
  • NPI 1336961119
  NPD
• Grady Memorial Hospital Corporation

  • Multi-Specialty Clinic/Center
  • Atlanta, GA
  • NPI 1649765686
  NPD
• Piedmont Providers LLC

  • Internal Medicine Physician
  • Jasper, GA
  • NPI 1548273592
  NPD (past)
• The Doctor'S Office, LLC

  • Family Medicine Physician
  • Stockbridge, GA
  • NPI 1578884516
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Grady Memorial Hospital Corporation

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1992799050
  Care Compare affiliation

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460332800000",
    "number": "1447317474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1255 HIGHWAY 54 W",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144526",
            "telephone_number": "404-367-3014",
            "fax_number": "404-367-3558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 HIGHWAY 54 W",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144526",
            "telephone_number": "404-367-3014",
            "fax_number": "404-367-3558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIS",
        "first_name": "SHALONDA",
        "middle_name": "B",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-02",
        "last_updated": "2016-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "004248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justice Malee Perry, BA
• Patricia T. Perry, PA
• Rachael Gabri Peterson, PA-C
• David Shane Petrie, DDS
• Janine Nicole Pettiford, M.D.
• Charles William Pettus, MD
• Brittany Petty
• Lindsay Spivey Petty, RD
• Phenix Enterprise Services, LLC
• Phenomenal Feeling Vitality Center

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2016; 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.