Provider Demographics
NPI:1336941590
Name:ELLIS, CHASITY
Entity type:Individual
Prefix:
First Name:CHASITY
Middle Name:
Last Name:ELLIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 WENTWORTH COVE CT
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-5218
Mailing Address - Country:US
Mailing Address - Phone:404-710-4397
Mailing Address - Fax:
Practice Address - Street 1:1272 WENTWORTH COVE CT
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-5218
Practice Address - Country:US
Practice Address - Phone:404-710-4397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No174200000XOther Service ProvidersMeals
No376K00000XNursing Service Related ProvidersNurse's Aide