Brandi Marisa Bazemore Ellis, M.S. CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP009766 Issued in GA

Practice address

508 Gentilly Rd
Statesboro, GA 30458-5149

Phone

(912) 681-7768

NPI assigned

Apr 29, 2020

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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.

• Therapy Spot LLC

  • Speech-Language Pathologist
  • Statesboro, GA
  • NPI 1083996755
  NPD

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

{
    "created_epoch": "1588118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588118400000",
    "number": "1659992808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 GENTILLY RD",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304585149",
            "telephone_number": "912-681-7768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 GENTILLY RD",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304585149",
            "telephone_number": "912-681-7768"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9104 Savannah Hwy",
            "address_purpose": "LOCATION",
            "city": "Newington",
            "state": "GA",
            "postal_code": "304462603",
            "country_code": "US",
            "telephone_number": "912-665-2690",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "BRANDI",
        "middle_name": "MARISA BAZEMORE",
        "name_prefix": "Mrs.",
        "credential": "M.S. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-29",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP009766",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elite Screenings & More LLC
• Elizabeth L Penn MD PC
• Abigail Fontaine Elkins
• Ellen N. Emerson, PHD, LLC
• Ellington Eyecare PLLC
• Patrice Ellison, LPN
• Otabek Elmurodov, M.D.
• Ellen N Emerson, PH.D
• Richard L. Emert, D.D.S.
• Hamilton Osasere Emokpae, M.D.

• Speech-Language Pathologist in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.