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NPI Code Detail

MEDICARE: ELLISTON LLC

MEDICARE: ELLISTON LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1992276596
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELLISTON LLC
Provider Business Mailing Address
First Line : 11560 GREAT OAKS WAY STE 300
Second Line :
City : ALPHARETTA
State : GA
Zip : 30022-2453
Country : US
Telephone Number : 404-474-0040
Fax Number : 404-704-0895
Provider Business Practice Location Address
First Line : 11560 GREAT OAKS WAY STE 300
Second Line :
City : ALPHARETTA
State : GA
Zip : 30022-2453
Country : US
Telephone Number : 404-474-0040
Fax Number : 404-704-0895
Authorized Official
Title or Position : MANAGER
Name : A KAY
Credential :
Telephone Number : 404-474-2212
Provider Enumeration Date : 12/08/2018
Last Update Date : 02/11/2026

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Directions to “ELLISTON LLC ” Practice Location

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