Individual
MISS SHERENDA LASHAWN ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1058 WEDGEWOOD CT, CONYERS, GA 30012-7120
(404) 453-7777
Mailing address
4351 HUGH HOWELL RD STE 1179, TUCKER, GA 30084-4721
(404) 453-7777
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
171WH0202X
Home Modifications Contractor
—
—
171WV0202X
Vehicle Modifications Contractor
—
—
246RP1900X
Phlebotomy Technician
Primary
9Y6C9J8J7
GA
251F00000X
Home Infusion Agency
—
GA
Other
Enumeration date
09/09/2020
Last updated
04/24/2026
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