Provider Demographics
NPI:1780835785
Name:COX, ELLEN WYCHE (MSW)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:WYCHE
Last Name:COX
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 RIDGEWAY RD
Mailing Address - Street 2:P. O. BOX 280
Mailing Address - City:WAVERLY HALL
Mailing Address - State:GA
Mailing Address - Zip Code:31831-2416
Mailing Address - Country:US
Mailing Address - Phone:706-582-2639
Mailing Address - Fax:
Practice Address - Street 1:2005 RIDGEWAY RD
Practice Address - Street 2:
Practice Address - City:WAVERLY HALL
Practice Address - State:GA
Practice Address - Zip Code:31905-2416
Practice Address - Country:US
Practice Address - Phone:706-544-4418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW001372104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker