Individual
KAMEELAH L. ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
33 UPPER RIVERDALE RD SW STE 21, RIVERDALE, GA 30274-2617
(404) 314-8868
Mailing address
PO BOX 1631, MCDONOUGH, GA 30253-1631
(404) 314-8868
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
179861
GA
Other
Enumeration date
08/02/2017
Last updated
08/02/2017
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