=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497419014
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EILATO CARE CONSULTING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2021
-----------------------------------------------------
Last Update Date | 10/29/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5960 CROOKED CREEK RD
-----------------------------------------------------
City | PEACHTREE CORNERS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30092-6219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-909-7531
-----------------------------------------------------
Fax | 470-766-1655
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3330 BARTLETT AVE
-----------------------------------------------------
City | CONYERS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30013-7503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-909-7531
-----------------------------------------------------
Fax | 470-766-1655
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / PROVIDER
-----------------------------------------------------
Name | FELECIA R PAUL-GREY
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 678-909-7531
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------