Individual
MR. JUSTIN THOMAS ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-BC, MSSM
Contact information
Practice address
1809 CANTON RD, MARIETTA, GA 30066-6343
(678) 335-4865
Mailing address
4314 SANDY POINTE, ACWORTH, GA 30101-4975
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2024093910
GA
Other
Enumeration date
01/08/2025
Last updated
10/13/2025
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