NPIMap

Organization Active NPI

Entelechy Rehab, LLC

  • Physical Therapy Clinic/Center
  • Conley, GA
National Provider Identifier
1881063576
Registry record updated Sep 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
ENTELECHY REHAB, LLC
Practice address
4015 Moore Creek Dr
Conley, GA 30288-1359
Phone
(404) 245-6807
NPI assigned
Sep 23, 2015
Last updated
Sep 23, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2015

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

Authorized official

Name
Dr. Nsikak Alex EssienumohNPI 1073832598
Title
Clinic Director
Phone
(404) 245-6807

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU Primary

Addresses

Primary practice location

4015 Moore Creek Dr
Conley, GA 30288-1359

Mailing address

3056 Anvil Block Rd Ste 118
Ellenwood, GA 30294-2864

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200117000469 GA Part B Supplier - Clinic/Group Practice 0547549131 Receives reassigned benefits from 4 practitioners
Practice locations: Ellenwood, GA

National Provider Directory

National Provider Directory

Locations

3056 Anvil Block Rd
Ste 118
Ellenwood, GA 30294
Phone (404) 366-8100

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1442966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442966400000",
    "number": "1881063576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3056 ANVIL BLOCK RD STE 118",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302942864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4015 MOORE CREEK DR",
            "city": "CONLEY",
            "state": "GA",
            "postal_code": "302881359",
            "telephone_number": "404-245-6807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENTELECHY REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-23",
        "last_updated": "2015-09-23",
        "status": "A",
        "authorized_official_last_name": "ESSIENUMOH",
        "authorized_official_first_name": "NSIKAK",
        "authorized_official_middle_name": "ALEX",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "404-245-6807",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conley, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2015; 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.