Provider Demographics
NPI:1689284085
Name:HOOD, ELLEN L
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:L
Last Name:HOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 BRIDLE POINT PKWY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-3350
Mailing Address - Country:US
Mailing Address - Phone:678-458-4047
Mailing Address - Fax:
Practice Address - Street 1:5130 BRIDLE POINT PKWY
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-3350
Practice Address - Country:US
Practice Address - Phone:678-458-4047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00000000000Other0000000