Active NPI
Kelly Ray Elliott, FNP
- Family Nurse Practitioner
- Chatsworth, GA
National Provider Identifier
1497798532
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 977575
- Practice address
- 2976 Highway 76
Ste B&C
Chatsworth, GA 30705-6981 - Phone
- (706) 517-0656
- Fax
- (706) 517-0651
- NPI assigned
- Jun 14, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 977575 | GA | Primary |
Addresses
Primary practice location
2976 Highway 76
Ste B&C
Chatsworth, GA 30705-6981
Mailing address
2976 Highway 76
Ste B&C
Chatsworth, GA 30705-6981
Phone (706) 517-0656
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 777482691 | Medicaid | GA |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 977575 | GA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Care Clinic LLC | Past | Accepting new patients | |
| Bates Family Medicine, PLLC | Past | Accepting new patients |
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 and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242000000000",
"number": "1497798532",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2976 HIGHWAY 76",
"address_2": "STE B&C",
"city": "CHATSWORTH",
"state": "GA",
"postal_code": "307056981",
"telephone_number": "706-517-0656",
"fax_number": "706-517-0651"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2976 HIGHWAY 76",
"address_2": "STE B&C",
"city": "CHATSWORTH",
"state": "GA",
"postal_code": "307056981",
"telephone_number": "706-517-0656",
"fax_number": "706-517-0651"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIOTT",
"first_name": "KELLY",
"middle_name": "RAY",
"name_prefix": "Mr.",
"credential": "FNP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-14",
"last_updated": "2009-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "GA",
"license": "977575",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "777482691",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chatsworth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.