Individual
DEANDREA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3655 ROSWELL RD NE STE 130A, ATLANTA, GA 30342-4428
(470) 472-1965
(470) 472-7964
Mailing address
3655 ROSWELL RD NE STE 130A, ATLANTA, GA 30342-4428
(470) 472-1965
(420) 472-1964
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
97622
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/23/2018
Last updated
01/07/2026
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