Provider Demographics
NPI:1497426845
Name:DANIELS-ELLISON, SUFFEARRIA MAKIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SUFFEARRIA
Middle Name:MAKIA
Last Name:DANIELS-ELLISON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
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Mailing Address - Street 1:85 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-7514
Mailing Address - Country:US
Mailing Address - Phone:478-290-2319
Mailing Address - Fax:478-552-9997
Practice Address - Street 1:131A VICTORY DR
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3234
Practice Address - Country:US
Practice Address - Phone:478-237-8342
Practice Address - Fax:478-237-8281
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA144562363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health