Terris Elliott, REEGT, CLTM

Primary specialty

Diagnostic Neuroimaging (Psychiatry & Neurology) PhysicianTaxonomy code 2084D0003X

License

499 Issued in GA

Practice address

207 North Ave
Villa Rica, GA 30180-1937

Phone

(770) 568-8881

NPI assigned

Jan 26, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1643155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1932851367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 NORTH AVE",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301801937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 NORTH AVE",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301801937",
            "telephone_number": "770-568-8881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "TERRIS",
        "name_prefix": "Mr.",
        "credential": "REEGT, CLTM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-26",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084E0001X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Epilepsy",
            "state": "GA",
            "license": "7353",
            "primary": false
        },
        {
            "code": "2084S0012X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": "TN",
            "license": "23874",
            "primary": false
        },
        {
            "code": "2084D0003X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Diagnostic Neuroimaging",
            "state": "GA",
            "license": "499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Diagnostic Neuroimaging (Psychiatry & Neurology) Physician in Villa Rica, GA
• Providers in Villa Rica, GA by specialty
• Diagnostic Neuroimaging (Psychiatry & Neurology) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; 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.