Elizabeth Candler Gregory Thomas

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10484 Issued in GA

Practice address

3334 Highway 155
Locust Grove, GA 30248-3513

Phone

(770) 305-7929

Fax

(770) 305-7969

NPI assigned

Apr 1, 2021

Sex

Female

Sole proprietor

Yes

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

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northside Surgical Professional Services LLCGroup PAC ID 8628253424, 367 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northside Hospital Cherokee Hospital, Canton, GA, CCN 110008

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Northside Surgical Professional Services LLC

  • Surgery Physician
  • Atlanta, GA
  • NPI 1356630990
  Medicare reassignment Care Compare group
• Qcpi-Villagemd, PC

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1558872432
  Medicare reassignment
• Venture Medical Associates LLC

  • Family Medicine Physician
  • Monticello, GA
  • NPI 1407281470
  NPD (past)

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

• Northside Hospital, Inc.

  • General Acute Care Hospital
  • Canton, GA
  • NPI 1225050396
  Care Compare affiliation

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

{
    "created_epoch": "1617235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1447838115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3334 HIGHWAY 155",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302483513",
            "telephone_number": "770-305-7929",
            "fax_number": "770-305-7969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3334 HIGHWAY 155",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302483513",
            "telephone_number": "770-305-7929",
            "fax_number": "770-305-7969"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "545 Venture Ct",
            "address_purpose": "LOCATION",
            "city": "Monticello",
            "state": "GA",
            "postal_code": "310647788",
            "country_code": "US",
            "telephone_number": "706-468-7002",
            "fax_number": "877-870-3481",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "210 College St",
            "address_purpose": "LOCATION",
            "city": "McDonough",
            "state": "GA",
            "postal_code": "302533300",
            "country_code": "US",
            "telephone_number": "470-878-6401",
            "fax_number": "470-878-6405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "ELIZABETH",
        "middle_name": "CANDLER GREGORY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-01",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "10484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Locust Grove, GA
• Providers in Locust Grove, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; 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.