Erin Ellison
Individual provider Active NPI Nurse Practitioner · Bremen, GA
NPI 1669710786 · NPPES record last updated Mar 26, 2025
Key facts
- NPI
- 1669710786
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- RN198477 (GA)
- Practice address
- 222 Gordon St
Bremen, GA 30110-1519 - Phone
- (770) 537-1234
- NPI assigned
- Jan 24, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Emory University School of Medicine, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- 316 Family Medicine
Practice addresses (Care Compare)
222 Gordon St
Bremen, GA 30110-1519
Phone (770) 537-1234
Hospital & facility affiliations
- Tanner Medical Center Villa Rica
- Tanner Medical Center - Carrollton
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130426000652 | GA | Practitioner - Nurse Practitioner | 9335385921 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN198477 | GA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellstar Medical Group, LLC | Current |
Accepting new patients | |
| Southside Medical Center, Inc | Current |
Accepting new patients | |
| Minuteclinic LLC | Nurse Practitioner | Current |
Accepting new patients |
| Wellstar Medical Group, LLC | Current |
Accepting new patients | |
| Southside Medical Center, Inc. | Current |
Accepting new patients | |
| Wellstar Medical Group, LLC | Current | Accepting new patients | |
| 3:16 Urgent Care LLC | Past | Accepting new patients |
Locations
1039 Ridge Ave SW
Atlanta, GA 30315
Phone (407) 761-8640
5150 Stilesboro Rd NW
Ste 120
Kennesaw, GA 30152
Phone (678) 354-0230
5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222
5095 Peachtree Pkwy
Norcross, GA 30092
Phone (770) 209-9299
11710 Alpharetta Hwy
Roswell, GA 30076
Phone (770) 754-0141
736 W Bankhead Hwy
Villa Rica, GA 30180
Phone (770) 459-8234
Interoperability endpoints
- erin.ellison.1@22071.direct.athenahealth.com
- eellison110670@directwellstar.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN198477 | GA | |
| Nurse Practitioner | 363L00000X | RN198477 | GA | Yes |
Addresses
Primary practice location
222 Gordon St
Bremen, GA 30110-1519
Mailing address
631 Grady Whitton Rd
Bremen, GA 30110-3573
Phone (404) 697-9529
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861915647 | Other | GA | GROUP NPI |
Other providers in Bremen, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2025. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.