Individual
JEFFERY ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11075 TARA GLYNN DR, HAMPTON, GA 30228-3324
(678) 720-6976
Mailing address
11075 TARA GLYNN DR, HAMPTON, GA 30228-3324
(678) 720-6976
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
GA
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
GA
Other
Enumeration date
10/21/2025
Last updated
02/17/2026
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