Individual
CAROLINE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1715 FOXWOOD GLN SE, CONYERS, GA 30013-6302
(470) 424-3142
Mailing address
1715 FOXWOOD GLN SE, CONYERS, GA 30013-6302
(470) 424-3142
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
12/28/2020
Last updated
12/28/2020
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