Ellen Suratt Stanback, RD,LD,CLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

LD001907 Issued in GA

Practice address

2277 Stone Mountain Lithonia Rd
Lithonia, GA 30058-5252

Phone

(770) 484-2600

Fax

(770) 484-3830

NPI assigned

Oct 25, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dekalb County Board of Health

  • Public Health or Welfare Agency
  • Decatur, GA
  • NPI 1750481982
  NPD (past)
• Dekalb County Board of Health

  • Public Health or Welfare Agency
  • Decatur, GA
  • NPI 1992801021
  NPD (past)

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780768663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3177 KENSINGTON RD",
            "city": "AVONDALE ESTATES",
            "state": "GA",
            "postal_code": "300021457",
            "telephone_number": "404-299-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2277 STONE MOUNTAIN LITHONIA RD",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300585252",
            "telephone_number": "770-484-2600",
            "fax_number": "770-484-3830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANBACK",
        "first_name": "ELLEN",
        "middle_name": "SURATT",
        "credential": "RD,LD,CLC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "GA",
            "license": "LD001907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna L. Springer, LCSW
• Muthayyah Srinivasan, MD
• Michelle Denise St Clair, HEALTH CARE PROVIDER
• Lesteena Johana Staines
• April Lavonne Stallworth, LPC
• Tiffany Stanton
• Patricia Staples
• Timothy T Stark
• Macaiyla Gabrielle Steadman
• Stellavilla

• Registered Dietitian in Lithonia, GA
• Providers in Lithonia, GA by specialty
• Registered Dietitian in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.