Individual
DR. INGRID A ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4795 JIMMY LEE SMITH PKWY, SUITE 101, HIRAM, GA 30141-2792
(770) 222-6362
(866) 528-7115
Mailing address
4795 JIMMY LEE SMITH PKWY, SUITE 101, HIRAM, GA 30141-2792
(770) 222-6362
(866) 528-7115
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
45207
GA
156FX1100X
Ophthalmic Technician/Technologist
Primary
45207
GA
Other
Enumeration date
11/30/2006
Last updated
02/08/2013
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