Individual
MR. JASON DANIEL ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
4510 NOCOHOMA BND, DOUGLASVILLE, GA 30135-8447
(678) 485-6905
Mailing address
4510 NOCOHOMA BND, DOUGLASVILLE, GA 30135-8447
(678) 485-6905
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN155630
GA
Other
Enumeration date
03/19/2007
Last updated
07/08/2007
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