Individual
MIREILLE F ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2650 HOLCOMB BRIDGE RD STE 510, ALPHARETTA, GA 30022-5374
(404) 255-4080
Mailing address
5835 LENOX PARK PL, BUFORD, GA 30518-7690
(602) 684-4682
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
001471
GA
363A00000X
Physician Assistant
6652
GA
Other
Enumeration date
04/03/2007
Last updated
04/19/2023
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