Individual
JARED S ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2201 JACK WARNER PKWY, TUSCALOOSA, AL 35401-1090
(205) 523-5618
Mailing address
2201 JACK WARNER PKWY, TUSCALOOSA, AL 35401-1090
(205) 523-5618
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17418
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051037554
—
AL
01
—
1750393682
GROUP NPI #
AL
05
—
1750393682
—
AL
05
—
529700760
—
AL
05
—
541003926
—
AL
05
—
541392605
—
AL
Enumeration date
07/29/2005
Last updated
09/01/2022
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