Healthcare Provider Details

I. General information

NPI: 1184873549
Provider Name (Legal Business Name): ROSINA IBETH ELLINGTON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 HIGHWAY 54 W
FAYETTEVILLE GA
30214-4526
US

IV. Provider business mailing address

165 COTTONBELLE DR
STOCKBRIDGE GA
30281-9146
US

V. Phone/Fax

Practice location:
  • Phone: 770-719-7256
  • Fax: 770-719-7378
Mailing address:
  • Phone: 770-389-7127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN186595
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: