Individual provider Active NPI

Monique Diane Petteys, FNP-C

  • Family Nurse Practitioner
  • Clayton, GA
National Provider Identifier
1902249675
Registry record updated Jan 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
GAANP004418 Issued in GA
Practice address
189 Bo James St Ste 105
Clayton, GA 30525-6199
Phone
(706) 782-0016
Fax
(706) 782-0180
NPI assigned
Apr 12, 2013
Last updated
Jan 21, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X GAANP004418 GA Primary

Addresses

Primary practice location

189 Bo James St Ste 105
Clayton, GA 30525-6199

Mailing address

647 Academy Rd
Long Creek, SC 29658-2105
Phone (706) 982-4434

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140428001431 GA Practitioner - Nurse Practitioner 8325271323 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Life Point Medical, LLCGroup PAC ID 1850679218, 4 clinicians

Practice addresses (Care Compare)

189 Bo James St
Suite 105
Clayton, GA 30525-6199
Phone (706) 782-0016

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
GAANP004418GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Life Point Medical, LLC CurrentSince Jul 13, 2020 Accepting new patients

Locations

189 Bo James St
Ste 105
Clayton, GA 30525
Phone (706) 782-0016

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14758/brand/1/csg/1/fhir/r4
  • Direct secure messaging: monique.kelly.1@13027.direct.athenahealth.com
  • Direct secure messaging: monique.petteys.1@14758.direct.athenahealth.com

Organizations & group practices 1

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

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1365724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768953600000",
    "number": "1902249675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "647 ACADEMY RD",
            "city": "LONG CREEK",
            "state": "SC",
            "postal_code": "296582105",
            "telephone_number": "706-982-4434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "189 BO JAMES ST STE 105",
            "city": "CLAYTON",
            "state": "GA",
            "postal_code": "305256199",
            "telephone_number": "706-782-0016",
            "fax_number": "706-782-0180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTEYS",
        "first_name": "MONIQUE",
        "middle_name": "DIANE",
        "name_prefix": "Ms.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-12",
        "last_updated": "2026-01-21",
        "certification_date": "2026-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "GAANP004418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clayton, GA

Sources for this page

Verify at the official NPI Registry.