Provider Demographics
NPI:1427807460
Name:ELLISTON PEDIATRICS LLC
Entity type:Organization
Organization Name:ELLISTON PEDIATRICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:A
Authorized Official - Middle Name:
Authorized Official - Last Name:KAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-474-2212
Mailing Address - Street 1:4279 ROSWELL RD NE STE 208-365
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3769
Mailing Address - Country:US
Mailing Address - Phone:404-474-2212
Mailing Address - Fax:404-704-0895
Practice Address - Street 1:157 TECHNOLOGY PKWY STE 600
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-3489
Practice Address - Country:US
Practice Address - Phone:404-474-2212
Practice Address - Fax:404-704-0895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty