Individual
FELICIA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1111 BAKER HWY W, DOUGLAS, GA 31533-2107
(912) 389-4458
(913) 389-4590
Mailing address
1111 BAKER HWY W, DOUGLAS, GA 31533-2107
(912) 389-4458
(913) 389-4590
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN101717
GA
363L00000X
Nurse Practitioner
Primary
RN101717
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000805912A
—
GA
Enumeration date
07/10/2006
Last updated
03/20/2023
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