Provider Demographics
NPI:1700877008
Name:ELLIS, CINDY L (EEG TECHNICIAN)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:L
Last Name:ELLIS
Suffix:
Gender:F
Credentials:EEG TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COLORADO CT
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-9523
Mailing Address - Country:US
Mailing Address - Phone:706-884-3502
Mailing Address - Fax:706-845-3700
Practice Address - Street 1:100 COLORADO CT
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-9523
Practice Address - Country:US
Practice Address - Phone:706-884-3502
Practice Address - Fax:706-845-3700
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEG