Individual
ESTHER ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
540 OLD FRONT ST APT 12, STONE MOUNTAIN, GA 30083-3340
(347) 352-1450
Mailing address
540 OLD FRONT ST APT 12, STONE MOUNTAIN, GA 30083-3340
(347) 352-1450
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
AMFT000521
GA
Other
Enumeration date
03/07/2018
Last updated
03/07/2018
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