Individual
JENNIFER HICKS ELLERBE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
1344 SWALLOWS WALK, GRAYSON, GA 30017-1736
(770) 364-2623
Mailing address
1344 SWALLOWS WALK, GRAYSON, GA 30017-1736
(770) 364-2623
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
199759
GA
Other
Enumeration date
12/17/2024
Last updated
12/17/2024
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