Individual
JOHN ELLIS IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
135 RUDDERS XING, NEWNAN, GA 30263-7032
(678) 994-2192
Mailing address
135 RUDDERS XING, NEWNAN, GA 30263-7032
(678) 994-2192
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH024504
GA
Other
Enumeration date
11/02/2020
Last updated
11/02/2020
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