Provider Demographics
NPI:1164798385
Name:CHU, ELLICA MOORE
Entity Type:Individual
Prefix:DR
First Name:ELLICA
Middle Name:MOORE
Last Name:CHU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:235 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-1401
Mailing Address - Country:US
Mailing Address - Phone:770-994-9326
Mailing Address - Fax:404-809-4284
Practice Address - Street 1:1412 MILSTEAD AVE NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3877
Practice Address - Country:US
Practice Address - Phone:770-918-3000
Practice Address - Fax:404-809-4284
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA75764207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine