Elite Healthcare Physical Medicine
Organization Active NPI General Practice Physician · Carrollton, GA
NPI 1669736120 · NPPES record last updated Jun 29, 2012
Key facts
- NPI
- 1669736120
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 052922 (GA)
- Legal business name
- ELITE HEALTHCARE PHYSICAL MEDICINE
- Practice address
- 307 Adamson SQ
Carrollton, GA 30117-3213 - Phone
- (770) 214-9146
- Fax
- (770) 214-9166
- NPI assigned
- Jun 29, 2012
- Organization subpart
- No
Authorized official
- Name
- Dr. Ryan C Weber
- Title
- Owner
- Phone
- (770) 214-9146
Practitioners 3
-
Julie Dorsch Weber, FNP-C
-
Ryan Christopher Weber, D.C.
-
Amy Jordan Eubanks, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130130000187 | GA | Part B Supplier - Clinic/Group Practice | 8325292212 |
Receives reassigned benefits from 3 practitioners Practice locations: Carrollton, GA |
National Provider Directory
Locations
418 Bradley St
Carrollton, GA 30117
Phone (770) 214-9146
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Chiropractor |
111NR0400X | CHIR007565 | GA | |
| General Practice Physician |
208D00000X | 052922 | GA | Yes |
| Family Nurse Practitioner |
363LF0000X | RN148627 | GA |
Addresses
Primary practice location
307 Adamson SQ
Carrollton, GA 30117-3213
Mailing address
307 Adamson SQ
Carrollton, GA 30117-3213
Phone (770) 214-9146
Other providers in Carrollton, GA
- Alanna Edwards
- Shatia Edwards
- Eliana Ege
- Ashlynn Deese Eison
- Mohamed Elgabrouny
- Meredith Jane Ellis
- Holly Ely
- Enchantment Nursing
- Kayla England
- Kathryn Grace Entrekin
All providers in Carrollton, GA · General Practice Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 2012. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.