Individual
IDA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
1874 SEWELL RD, GRANTVILLE, GA 30220-2609
(770) 755-7020
(770) 755-7020
Mailing address
1874 SEWELL RD, GRANTVILLE, GA 30220-2609
(770) 755-7020
(770) 755-7020
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
CN0030019746
GA
Other
Enumeration date
02/03/2026
Last updated
02/03/2026
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