Individual
MISS ELLISA A MATHIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP'C
Contact information
Practice address
409 UVALDA ST, WAYCROSS, GA 31501-4574
(912) 283-1359
(912) 283-1362
Mailing address
800 BEACON ST, WAYCROSS, GA 31501-7104
(912) 287-4434
(912) 287-9964
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN068928
GA
Other
Enumeration date
08/25/2006
Last updated
10/30/2009
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