OrganizationEllen Paige Montgomery, LlcCounselorBehavioral Health & Social Service ProvidersPractice Address1807 Over Lake Dr SE, Suite C, Conyers, GA 30013-1777(678) 413-3833PECOS EnrollmentBased on the most recent information from CMS, provider Ellen Paige Montgomery, Llc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 2:25 PM.Profile DetailsProvider ID1871828509Provider TypeOrganizationFull NameEllen Paige Montgomery, LlcSubpartNoEnumeration Date10/14/2009Last Updated10/14/2009Contact InformationPractice LocationPractice Address1807 Over Lake Dr SE, Suite C, Conyers, GA 30013-1777Phone(678) 413-3833Fax(770) 385-1832Mailing LocationMailing Address1807 Over Lake Dr SE, Suite C, Conyers, GA 30013-1777Phone(678) 413-3833Fax(770) 385-1832Authorized OfficialNameMontgomery, Ellen Paige (Owner)Phone(678) 413-3833Provider TaxonomiesCodeDescriptionLicenseCode101YP2500XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicense4154GeorgiaProvider IdentifiersIDDescriptionIssuerID200566262ADescriptionMedicaidIssuerUnlistedGeorgia