Individual
MRS. PATRICIA MARIE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1265 HIGHWAY 54 W, SUITE 102, FAYETTEVILLE, GA 30214-4548
(770) 460-1900
(770) 719-1214
Mailing address
900 CIRCLE 75 PKWY SE, STE 1700, ATLANTA, GA 30339-3087
(919) 497-8411
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
007859
GA
Other
Enumeration date
10/04/2005
Last updated
06/03/2016
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