Individual
KELVIN ELLIS SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
285 W WIEUCA RD NE, ATLANTA, GA 30342-3321
(470) 705-1500
Mailing address
1030 DECLARATION CT, MCDONOUGH, GA 30253-7905
(470) 549-4523
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
01/11/2024
Last updated
01/11/2024
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