Healthcare Provider Details

I. General information

NPI: 1730528464
Provider Name (Legal Business Name): ELLIS EVALUATION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2013
Last Update Date: 06/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 CUMBERLAND PKWY SE BLDG 500-140
ATLANTA GA
30339-4524
US

IV. Provider business mailing address

2255 CUMBERLAND PKWY SE BLDG 500-140
ATLANTA GA
30339-4524
US

V. Phone/Fax

Practice location:
  • Phone: 678-538-6450
  • Fax:
Mailing address:
  • Phone: 678-538-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003274
License Number StateGA

VIII. Authorized Official

Name: DR. MESHA L. ELLIS
Title or Position: OWNER/PSYCHOLOGIST
Credential: PHD
Phone: 678-538-6450