Success Dynamics Incorporated

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

SUCCESS DYNAMICS INCORPORATED

Doing business as

Success Dynamics Incorporated

Practice address

2056 W Park Place Blvd Ste D
Stone Mountain, GA 30087-3537

Phone

(678) 318-3622

NPI assigned

May 10, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Calvin Oliver Ellison

Title

Ceo

Phone

(252) 717-5930

Specialties & licenses 1

Addresses

Other names 1

• Success Dynamics Incorporated Doing business as

Locations

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

{
    "created_epoch": "1620604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620604800000",
    "number": "1669056313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2056 W PARK PLACE BLVD STE D",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873537",
            "telephone_number": "678-318-3622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2056 W PARK PLACE BLVD STE D",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873537",
            "telephone_number": "678-318-3622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUCCESS DYNAMICS INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-10",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A",
        "authorized_official_last_name": "ELLISON",
        "authorized_official_first_name": "CALVIN",
        "authorized_official_middle_name": "OLIVER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "252-717-5930",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Success Dynamics Incorporated",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2021; 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.