Individual
MISS JESSICA ERIN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
500 BETHANY WOODS DR, TEMPLE, GA 30179-3574
(205) 902-4928
Mailing address
306 PELHAM ST, CHICKASAW, AL 36611-2410
(205) 902-4928
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1-107940
AL
163W00000X
Registered Nurse
Primary
RN189320
GA
Other
Enumeration date
02/01/2008
Last updated
02/01/2008
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