Organization
FPA
Active
Organization
FPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID ELLIS (CEO)
(762) 231-5806
Entity
Organization
Contact information
Practice address
407 N THORNTON AVE STE 4, DALTON, GA 30720-3549
(762) 231-5806
Mailing address
407 N THORNTON AVE STE 4, DALTON, GA 30720-3549
(762) 231-5806
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
—
—
103TC0700X
Clinical Psychologist
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
03/25/2024
Last updated
03/25/2024
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up