Elite Family Practice

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

041745 Issued in GA

Legal business name

ELITE FAMILY PRACTICE

Practice address

6126 Prestley Mill Rd
Suite H
Douglasville, GA 30134-5623

Phone

(678) 715-2993

Fax

(678) 715-2827

NPI assigned

Sep 5, 2012

Organization subpart

No

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

Authorized official

Name

Delania W Miles

Title

Office Manager

Phone

(678) 715-2993

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/16081/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Valencia R Burruss, M.D.

  • Family Medicine Physician
  • Douglasville, GA
  • NPI 1215972823
  Medicare reassignment

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

{
    "created_epoch": "1346803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346803200000",
    "number": "1710236880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6126 PRESTLEY MILL RD",
            "address_2": "SUITE H",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301345623",
            "telephone_number": "678-715-2993",
            "fax_number": "678-715-2827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6126 PRESTLEY MILL RD",
            "address_2": "SUITE H",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301345623",
            "telephone_number": "678-715-2993",
            "fax_number": "678-715-2827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-05",
        "last_updated": "2012-09-05",
        "status": "A",
        "authorized_official_last_name": "MILES",
        "authorized_official_first_name": "DELANIA",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "678-715-2993"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "GA",
            "license": "041745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ihuoma Joyce Ejisoby
• Amalachukwu Eke-Okoro
• Odinakachi Eke-Okoro
• Rafiq M. El Hammali, MD
• Khaled Elchoufi
• Elitejourney LLC
• Ella'S Day Services
• Thomas Cecil Ellington, D.D.S.
• Jason Daniel Ellis, RN
• Tammie Ellis, MA

• Preferred Provider Organization in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Preferred Provider Organization in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2012; 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.