Elite Behavioral Medicine LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

20292 Issued in GA

Legal business name

ELITE BEHAVIORAL MEDICINE LLC

Practice address

1800 Hog Mountain Rd
BLDG 100, Ste 103
Watkinsville, GA 30677

Phone

(770) 910-2279

NPI assigned

Jul 23, 2018

Last updated

Apr 9, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael Boyd, PA-CNPI 1659315612

Title

Ceo

Phone

(770) 910-2279

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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.

• Michael Boyd, PA

  • Medical Physician Assistant
  • Watkinsville, GA
  • NPI 1659315612
  Authorized official Same address or phone
• Roberto Norniella, MD

  • Psychiatry Physician
  • Monroe, GA
  • NPI 1487609830
  NPD (past)

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

{
    "created_epoch": "1532304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712620800000",
    "number": "1932686904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 HOG MOUNTAIN RD",
            "address_2": "BLDG 100, STE 103",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "30677",
            "telephone_number": "706-410-1033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 HOG MOUNTAIN RD",
            "address_2": "BLDG 100, STE 103",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "30677",
            "telephone_number": "770-910-2279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE BEHAVIORAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-23",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A",
        "authorized_official_last_name": "BOYD",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-910-2279",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "GA",
            "license": "20292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Edenfield, BCBA
• Frankie Allen Edens Jr.
• Rielly Shea Edling
• Alice L Edwards, MD
• Kenneth Eugene Edwards, OTR/L
• Elite Mobile Phlebotomist of Georgia
• Holly Marie Elliott
• England Counseling and Behavioral Services LLC
• Jennifer Amber England, L.P.C.
• Patricia Grace Ennis, MOTR/L

• Clinic/Center in Watkinsville, GA
• Providers in Watkinsville, GA by specialty
• Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; 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.