Individual
JACKIE DWAYNE ELLINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
EMT
Contact information
Practice address
1548 OLD HWY 5 SOUTH, ELLIJAY, GA 30540
(706) 273-7477
(706) 276-8474
Mailing address
PO BOX 1725, ELLIJAY, GA 30540-0033
(706) 273-7477
(706) 276-8474
Taxonomy
Speciality
Code
Description
License number
State
146M00000X
Intermediate Emergency Medical Technician
Primary
28696
GA
Other
Enumeration date
09/18/2012
Last updated
09/18/2012
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