Elite Medical Group

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

ELITE MEDICAL GROUP

Practice address

3965 Glen Park Dr
Lithonia, GA 30038-3692

Phone

(404) 561-5714

NPI assigned

Jun 4, 2012

Last updated

Jun 4, 2012By 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

Julian Suter

Title

Owner

Phone

(404) 561-5714

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1338768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338768000000",
    "number": "1700147063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3965 GLEN PARK DR",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300383692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3965 GLEN PARK DR",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300383692",
            "telephone_number": "404-561-5714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-04",
        "last_updated": "2012-06-04",
        "status": "A",
        "authorized_official_last_name": "SUTER",
        "authorized_official_first_name": "JULIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-561-5714"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Lithonia, GA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2012; 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.