Ellis, Elizabeth Myrna
Ellis, Elizabeth Myrna is an sole proprietor health care provider with primary practice located at 801 Amsterdam Ave Ne , Atlanta GA 30306-3403. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Ellis, Elizabeth Myrna can be contacted via phone (770) 337-9446.Contact Information
Primary practice address
801 Amsterdam Ave Ne
Atlanta GA 30306-3403
Phone: (770) 337-9446
Fax: (770) 476-0377
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 521 | Georgia |
Profile Details
| NPI number | 1053478503 |
|---|---|
| LBN Legal business name | Ellis, Elizabeth Myrna |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 3rd, 2007 |
| Last updated | Aug 7th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1053478503 | NPPES |
| Georgia | MEDICAID | 00196171B |
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