Eliza Johnson Bacot, NP
Individual provider Active NPI Critical Care Medicine Nurse Practitioner · Newnan, GA
NPI 1891973483 · NPPES record last updated Nov 17, 2014
Key facts
- NPI
- 1891973483
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Critical Care Medicine Nurse Practitioner 363LC0200X
- License
- RN168366 (GA)
- Practice address
- 600 Celebrate Life Pkwy
Newnan, GA 30265-8001 - Phone
- (678) 907-2999
- NPI assigned
- Feb 5, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080515000653 | GA | Practitioner - Nurse Practitioner | 3072682137 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Interoperability endpoints
- ebacot21437@direct.emory.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine Nurse Practitioner | 363LC0200X | RN168366 | GA | Yes |
Addresses
Primary practice location
600 Celebrate Life Pkwy
Newnan, GA 30265-8001
Mailing address
600 Celebrate Life Pkwy
Newnan, GA 30265-8001
Phone (678) 907-2999
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 220573126A | Medicaid | GA |
Other providers in Newnan, GA
- Rohit Kumar Avula
- Awaken,Inspire,Restore LLC
- Mark E Axness
- Jared Babb
- Baby Dimensions
- Idrissatu Bah
- Darron P Baham
- Rugiatu Bahr
- Jason Aaron Bailey
- Julianne Baily
All providers in Newnan, GA · Critical Care Medicine Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 17, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.