Healthcare Provider Details

I. General information

NPI: 1346734217
Provider Name (Legal Business Name): ELLA MICHELLE STEPHENSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELLA WEAVER RN

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 08/02/2025
Certification Date: 08/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 MILSTEAD RD NE STE 101
CONYERS GA
30012-3824
US

IV. Provider business mailing address

1315 MILSTEAD RD NE STE 101
CONYERS GA
30012-3824
US

V. Phone/Fax

Practice location:
  • Phone: 470-545-0860
  • Fax: 470-300-7778
Mailing address:
  • Phone: 470-217-8445
  • Fax: 470-545-0860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN200419
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN200419
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN400219
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN200419
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN200419
License Number StateGA
# 6
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN200419
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: