Provider Demographics
NPI:1902598907
Name:ELLINGTON, MOLLIE MAE (RN)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:MAE
Last Name:ELLINGTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:MAE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3625 KNOLL CREST TRL
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-5074
Mailing Address - Country:US
Mailing Address - Phone:678-833-4123
Mailing Address - Fax:
Practice Address - Street 1:80 JESSE HILL JR DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3031
Practice Address - Country:US
Practice Address - Phone:678-833-4123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN195588163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice