Ellijay Center for Change, PC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CSW001990 Issued in GA

Legal business name

ELLIJAY CENTER FOR CHANGE, PC

Practice address

89 Hospital Cir
Suite 8
Ellijay, GA 30540-9669

Phone

(706) 698-2400

Fax

(706) 698-2401

NPI assigned

Nov 30, 2009

Last updated

Nov 30, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Cheryl Keats, LCSWNPI 1841254307

Title

Owner

Phone

(706) 698-2400

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Cheryl M. Keats, LCSW

  • Clinical Social Worker
  • Ellijay, GA
  • NPI 1841254307

  SC

  Medicare reassignment Authorized official
• David John Berndt, PH.D.

  • Clinical Psychologist
  • North Charleston, SC
  • NPI 1821377946
  NPD (past)
• Cayce C. Tangeman, M.D.

  • Family Medicine Physician
  • Goose Creek, SC
  • NPI 1932210929
  NPD (past)

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

{
    "created_epoch": "1259539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259539200000",
    "number": "1669700837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "89 HOSPITAL CIR",
            "address_2": "SUITE 8",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305409669",
            "telephone_number": "706-698-2400",
            "fax_number": "706-698-2401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89 HOSPITAL CIR",
            "address_2": "SUITE 8",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305409669",
            "telephone_number": "706-698-2400",
            "fax_number": "706-698-2401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIJAY CENTER FOR CHANGE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-30",
        "last_updated": "2009-11-30",
        "status": "A",
        "authorized_official_last_name": "KEATS",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-698-2400",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "CSW001990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dialysis of North Atlanta LLC (Ellijay Dialysis)
• Dietary Apothecary Inc.
• Michael R Doucette Jr., LDO
• Draneco Inc (Ellijays Bestrx)
• Bradleigh Dyer-McPherson, FNP
• Jackie Dwayne Ellington, EMT
• Stacey Lynne Evans-Paulin, PA-C
• Family Life Chiropractic Center III
• Robert Stephen Feldman, MD
• Marissa Lee Fidler, PA-C

• Mental Health Counselor in Ellijay, GA
• Providers in Ellijay, GA by specialty
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.