Peridot and Emerald Mobile Services, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PERIDOT AND EMERALD MOBILE SERVICES, LLC

Practice address

1315 Milstead Rd NE Ste 101
Conyers, GA 30012-3824

Phone

(470) 545-0860

Fax

(470) 300-7778

NPI assigned

Aug 9, 2021

Last updated

Apr 17, 2023By 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

Mrs. Ella Michelle Stephenson, RNNPI 1346734217

Title

Administrator

Phone

(470) 545-0860

Specialties & licenses 2

Addresses

Practitioners 1

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.

• Ella Michelle Stephenson, RN

  • Administrator Registered Nurse
  • Conyers, GA
  • NPI 1346734217
  Authorized official Same address or phone

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

{
    "created_epoch": "1628467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681689600000",
    "number": "1699440016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2890 GEORGIA HIGHWAY 212 SW STE A106",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300943363",
            "telephone_number": "470-545-0860",
            "fax_number": "470-300-7778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 MILSTEAD RD NE STE 101",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123824",
            "telephone_number": "470-545-0860",
            "fax_number": "470-300-7778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIDOT AND EMERALD MOBILE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-09",
        "last_updated": "2023-04-17",
        "certification_date": "2023-04-17",
        "status": "A",
        "authorized_official_last_name": "STEPHENSON",
        "authorized_official_first_name": "ELLA",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "470-545-0860",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pelagie Foundation LTD (Pelagie Resource Center)
• Shazzanne Kahelia Pennant, MD
• Larry Pennington, RPH
• Gustavo Andre Perez Caballero, BS, DC, GTS
• Performance Chiropractic of Georgia
• Periodontal Center of Georgia, PC (Periodontal Center of Georgia)
• Personal Touch Healthcare LLC.
• Kimberly Anne Peters, DMD
• Shalisa Peterson
• Hung Pham, M.D.

• Clinical Medical Laboratory in Conyers, GA
• Providers in Conyers, GA by specialty
• Clinical Medical Laboratory in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2023; 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.