Provider Demographics
NPI:1205294279
Name:ELLETT, CINDY MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:MARIE
Last Name:ELLETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9876 MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3970
Mailing Address - Country:US
Mailing Address - Phone:770-516-1050
Mailing Address - Fax:770-516-1300
Practice Address - Street 1:203 WOODPARK PL. BLDG B. 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188
Practice Address - Country:US
Practice Address - Phone:770-516-1050
Practice Address - Fax:770-516-1300
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN173206163W00000X, 163WC0200X, 163WE0003X, 163WG0000X, 163WH1000X, 163WS0200X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WS0200XNursing Service ProvidersRegistered NurseSchool