Provider Demographics
NPI:1346681186
Name:ELLIS, EMILY MICHELLE (AUD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:MICHELLE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4441 ATLANTA RD SE STE 205
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6442
Mailing Address - Country:US
Mailing Address - Phone:770-801-5020
Mailing Address - Fax:
Practice Address - Street 1:4441 ATLANTA RD SE STE 205
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6442
Practice Address - Country:US
Practice Address - Phone:770-801-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD60387736231H00000X
GAAUD004056231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist