Healthcare Provider Details

I. General information

NPI: 1316676166
Provider Name (Legal Business Name): DELILAH ELLZEY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 CLIFTON RD NE FLOOR 4 - PSYCHOLOGY SUITE
ATLANTA GA
30322-1060
US

IV. Provider business mailing address

2521 PIEDMONT RD NE APT 2419
ATLANTA GA
30324-6271
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-8462
  • Fax:
Mailing address:
  • Phone: 312-841-8752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: