| Ellie Mental Health | |
|
10700 Medlock Bridge Rd Ste 101 Johns Creek GA 30097-8455 | |
| (404) 791-0832 | |
| Not Available |
| Full Name | Ellie Mental Health |
|---|---|
| Speciality | Psychologist |
| Location | 10700 Medlock Bridge Rd Ste 101, Johns Creek, Georgia |
| Authorized Official Name and Position | Mary Margaret Waymire (OWNER) |
| Authorized Official Contact | 4047910832 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellie Mental Health 705 Henley Fields Cir Johns Creek GA 30097-5924 Ph: (404) 791-0832 | Ellie Mental Health 10700 Medlock Bridge Rd Ste 101 Johns Creek GA 30097-8455 Ph: (404) 791-0832 |
| NPI Number | 1376269738 |
|---|---|
| Provider Enumeration Date | 10/18/2022 |
| Last Update Date | 02/19/2024 |
| Certification Date | 02/19/2024 |
| Medicare PECOS PAC ID | 4789040445 |
|---|---|
| Medicare Enrollment ID | O20230523000423 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376269738 | NPI | - | NPPES |
| Provider Name | Jessica Jenkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013635481 PECOS PAC ID: 1759747421 Enrollment ID: I20230523000510 |
| Provider Name | Synita Mequinn Hudgins |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1811285836 PECOS PAC ID: 9133585896 Enrollment ID: I20230607001701 |
| Provider Name | Tatiana Nicole Pelt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982273330 PECOS PAC ID: 8426409277 Enrollment ID: I20240105003324 |
| Provider Name | Dorothy Firth Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1407360787 PECOS PAC ID: 2769833201 Enrollment ID: I20240109001459 |
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