Healthcare Provider Details

I. General information

NPI: 1487216636
Provider Name (Legal Business Name): ALEXANDRA ROSE GELLIN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 FAYETTEVILLE RD SE
ATLANTA GA
30316-2932
US

IV. Provider business mailing address

878 PEACHTREE ST NE APT 705
ATLANTA GA
30309-4410
US

V. Phone/Fax

Practice location:
  • Phone: 404-324-4190
  • Fax:
Mailing address:
  • Phone: 404-985-5955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: