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ELITE FAMILY PRACTICE
NPI 1710236880
Preferred Provider Organization in Douglasville, GA

Active since September 05, 2012CLIA 11D0998471 · Microscopy
6126 PRESTLEY MILL RD, SUITE H, DOUGLASVILLE, GA 30134(678) 715-2993(678) 715-2827 Get Directions Write a Review

NPPES record last updated: September 5, 2012. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Elite Family Practice NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ELITE FAMILY PRACTICE (NPI 1710236880) is a healthcare organization registered as a preferred provider organization in Douglasville, Georgia and active in the NPI registry since September 2012. The organization holds a CLIA Microscopy certificate valid through April 15, 2028 and lists Delania W Miles, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1710236880
Entity TypeOrganization
Primary Taxonomy305R00000X
Legal Business NameELITE FAMILY PRACTICE
Location Address6126 PRESTLEY MILL RD, SUITE HDouglasville, GA 30134-5623
Mailing Address6126 Prestley Mill Rd, Suite HDouglasville, GA 30134-5623 · (678) 715-2993 · Fax (678) 715-2827
Phone(678) 715-2993
Fax(678) 715-2827
Organization SubpartNo
Authorized OfficialDelania W MilesOffice Manager · (678) 715-2993
Enumeration DateSeptember 5, 2012
✔ NPI 1710236880 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPreferred Provider OrganizationManaged Care Organizations
Taxonomy Code305R00000X
License✔ Licensed in GA · 041745
Definition
A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level.
6126 PRESTLEY MILL RD, Douglasville, GA 30134
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Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Elite Family Practice is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Elite Family Practice, which bills Medicare for the services this clinician delivers.

Clinician (1)

Valencia Burruss, M.D.
Family Practice
NPI 1215972823
6126 PRESTLEY MILL RD STE H
Douglasville, GA 30134
(678) 715-2993
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 11D0998471

Elite Family Practice PC · Douglasville, GA
Active · expires Apr 15, 2028
CLIA Number11D0998471
Laboratory TypePhysician Office
Certificate Effective DateApril 16, 2026
Certificate Expiration DateApril 15, 2028
Laboratory DirectorValencia Burruss
Laboratory Phone(770) 745-6225
Laboratory LocationElite Family Practice PC6126 Prestley Mill Road, Suite H, Douglasville, GA 30134
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Elite Family Practice's NPI number?

The NPI number for Elite Family Practice is 1710236880. It was assigned to this organization in the NPPES registry on September 5, 2012.

Where is Elite Family Practice located?

Elite Family Practice is located at 6126 Prestley Mill Rd Suite H, Douglasville, GA 30134. The listed phone number is (678) 715-2993.

What is Elite Family Practice's specialty?

The primary specialty registered for this NPI is Preferred Provider Organization with taxonomy code 305R00000X.

Is Elite Family Practice enrolled in Medicare?

Yes. Elite Family Practice is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Elite Family Practice?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Elite Family Practice. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Elite Family Practice hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 11D0998471) is associated with this NPI, valid through April 15, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Elite Family Practice was last updated on September 5, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.