Individual
BRANDON LEE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-S
Contact information
Practice address
1104 ELM GROVE AVE, GAINESVILLE, GA 30501-3901
(850) 450-0002
Mailing address
1104 ELM GROVE AVE, GAINESVILLE, GA 30501-3901
(850) 450-0002
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
GA
Other
Enumeration date
05/21/2025
Last updated
05/21/2025
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