Individual provider Active NPI

Elizabeth Catherine Tully, DC

  • Chiropractor
  • Locust Grove, GA
National Provider Identifier
1568568491
Registry record updated Sep 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
GA6332 Issued in GA
Practice address
835 Jackson St
Locust Grove, GA 30248-4137
Phone
(770) 898-0028
Fax
(770) 898-7987
NPI assigned
Sep 16, 2006
Last updated
Sep 30, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X GA6332 GA Primary

Addresses

Primary practice location

835 Jackson St
Locust Grove, GA 30248-4137

Mailing address

835 Jackson St
Locust Grove, GA 30248-4137
Phone (770) 898-0028

Other identifiers 2

IdentifierTypeStateIssuer
801714OtherGABLUE CROSS BLUE SHIELD
DOL205152800OtherGADEPARTMENT OF LABOR

Other names 1

  • Dr. Elizabeth Catherine Plante Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120330000357 GA Practitioner - Chiropractic 5698935591 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 1998
Medicare assignment
May accept Medicare assignment
Group practices
Locust Grove Clinic, P.C.Group PAC ID 5395733539, 2 clinicians

Practice addresses (Care Compare)

835 Jackson St
Locust Grove, GA 30248-4137
Phone (770) 898-0028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
GA6332GAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Locust Grove Clinic, P.C. Chiropractor CurrentSince Jul 1, 2001 Accepting new patients

Locations

835 Jackson St
Locust Grove, GA 30248
Phone (770) 898-0028

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317340800000",
    "number": "1568568491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "835 JACKSON ST",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302484137",
            "telephone_number": "770-898-0028",
            "fax_number": "770-898-7987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 JACKSON ST",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302484137",
            "telephone_number": "770-898-0028",
            "fax_number": "770-898-7987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULLY",
        "first_name": "ELIZABETH",
        "middle_name": "CATHERINE",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-16",
        "last_updated": "2011-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "GA6332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "801714",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LABOR",
            "identifier": "DOL205152800",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "PLANTE",
            "middle_name": "CATHERINE",
            "prefix": "DR.",
            "credential": "DC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Locust Grove, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.