Individual
MRS. LATRESE ANN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3800 PRINCETON LAKES PKWY SW, ATLANTA, GA 30331-5580
(404) 948-3019
Mailing address
5764 PEACHTREE INDUSTRIAL BLVD # 4505, CHAMBLEE, GA 30341-1908
(770) 457-4401
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
RN165019
GA
363LF0000X
Family Nurse Practitioner
Primary
RN165019
GA
Other
Enumeration date
03/28/2014
Last updated
10/08/2025
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