Provider Demographics
NPI:1114741402
Name:DELLINGER, ELLEN KENDALL (APRN)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:KENDALL
Last Name:DELLINGER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 WHITEHEAD DR
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-2451
Mailing Address - Country:US
Mailing Address - Phone:678-350-3068
Mailing Address - Fax:
Practice Address - Street 1:1731 MERIWEATHER DR STE 100
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7746
Practice Address - Country:US
Practice Address - Phone:706-431-5368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN242639363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty