Angela Montgomery Eells, LCSW
Individual provider Active NPI Clinical Social Worker · Gray, GA
NPI 1578892477 · NPPES record last updated Dec 24, 2009
Key facts
- NPI
- 1578892477
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 4277 (GA)
- Practice address
- 111 Dolly St
Gray, GA 31032-5307 - Phone
- (478) 491-1991
- NPI assigned
- Dec 24, 2009
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100222000434 | GA | Practitioner - Clinical Social Worker | 8022152586 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4277 | GA | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 4277 | GA | Yes |
Addresses
Primary practice location
111 Dolly St
Gray, GA 31032-5307
Mailing address
PO Box 818
Gray, GA 31032-0818
Phone (478) 491-1991
Other providers in Gray, GA
- Maria Flordesol Abuloc Culpa-Bondal
- Terri Brown Cunningham
- Sabine Doirin
- Ashley Danielle Douglas
- Dsi Macon, LLC
- Tory Kirsten Etheridge
- Natalie F Evans
- Ga Pain and Behavioral Medicine Inc.
- Marci Gallagher
- Lacy Lee Gardner-Hattaway
All providers in Gray, GA · Clinical Social Worker in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 24, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.