Individual
DR. SHANNON SCOTT ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
26 W JACKSON COMMONS DR, HOSCHTON, GA 30548-1897
(706) 658-2452
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
072568
GA
207Q00000X
Family Medicine Physician
2007-01049
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5912656
—
NC
Enumeration date
08/08/2007
Last updated
10/06/2020
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