Individual provider Active NPI

John Frederick Elder, M.D.

  • Obstetrics & Gynecology Physician
  • Athens, GA
National Provider Identifier
1992781132
Registry record updated Feb 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
020098 Issued in GA
Practice address
1199 Prince Ave
Athens, GA 30606-2797
Phone
(706) 475-7000
Fax
(706) 475-6676
NPI assigned
Dec 20, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 020098 GA Primary

Addresses

Primary practice location

1199 Prince Ave
Athens, GA 30606-2797

Mailing address

700 Sunset Dr
Suite 601
Athens, GA 30606-2293
Phone (706) 548-4754

Other identifiers 1

IdentifierTypeStateIssuer
000188108BMedicaidGA

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081229000170 GA Practitioner - Obstetrics/Gynecology 2961564984 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
020098GAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southside Medical Center, Inc. CurrentSince Apr 1, 2016 Accepting new patients
Southside Medical Center, Inc CurrentSince Apr 1, 2016 Accepting new patients
Piedmont Athens Hospitalist Physicians LLC CurrentSince Aug 1, 2018 Accepting new patients
Obhg Georgia, P.C. Obstetrics & Gynecology CurrentSince Jun 1, 2015 Accepting new patients

Locations

1199 Prince Ave
Athens, GA 30606
Phone (706) 354-3520

1230 Baxter St
Athens, GA 30606
Phone (706) 364-3100

1039 Ridge Ave SW
Atlanta, GA 30315
Phone (407) 761-8640

1035 Red Bud Rd NE
Calhoun, GA 30701
Phone (706) 602-7800

1514 Vernon Rd
Lagrange, GA 30240
Phone (706) 812-2369

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518566400000",
    "number": "1992781132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 SUNSET DR",
            "address_2": "SUITE 601",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062293",
            "telephone_number": "706-548-4754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1199 PRINCE AVE",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062797",
            "telephone_number": "706-475-7000",
            "fax_number": "706-475-6676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELDER",
        "first_name": "JOHN",
        "middle_name": "FREDERICK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-20",
        "last_updated": "2018-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "020098",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000188108B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Athens, GA

Sources for this page

Verify at the official NPI Registry.