Individual
ELLIE MARIE PONTIAKOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4700 WATERS AVE, SAVANNAH, GA 31404-6220
(912) 350-8000
Mailing address
885 RIVER BLUFF RD, NORTH AUGUSTA, SC 29841-6056
(704) 577-3998
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12577
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/29/2024
Last updated
10/04/2024
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