Individual
MS. LINDA A ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA, LMT
Contact information
Practice address
2484 INGLESIDE AVE, SUITE 108, MACON, GA 31204-2089
(478) 719-2424
Mailing address
3974 EASY ST, MACON, GA 31204-4726
(478) 719-2424
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT 000308
GA
Other
Enumeration date
03/12/2012
Last updated
03/12/2012
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