Individual
MS. LAURA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN
Contact information
Practice address
1100 JOHNSON FERRY RD NE, SUITE 600, SANDY SPRINGS, GA 30342-1709
(404) 256-4777
(404) 256-5515
Mailing address
1835 SAVOY DR, SUITE 300, ATLANTA, GA 30341-1072
(770) 496-9400
(770) 496-9495
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN050577
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000885739C
—
GA
01
—
CA9328
MEDICARE GROUP-DMERC
GA
Enumeration date
01/10/2006
Last updated
01/14/2011
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