Provider Demographics
NPI:1609505296
Name:ELLISON, DEBORAH KAY CHADWICK
Entity Type:Individual
Prefix:
First Name:DEBORAH KAY
Middle Name:CHADWICK
Last Name:ELLISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:
Other - Last Name:WHITE-ELLISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:919 LAWYERS LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-3129
Mailing Address - Country:US
Mailing Address - Phone:706-256-3200
Mailing Address - Fax:706-317-2177
Practice Address - Street 1:919 LAWYERS LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-3129
Practice Address - Country:US
Practice Address - Phone:706-256-3200
Practice Address - Fax:706-317-2177
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities