NPI 1003115254

Jack Bradley Ellis, DO

Practitioner Internal Medicine Physician Augusta, GA

Practice location

Address: 1120 15th St, Augusta, GA 30912
Phone: (706) 721-8623
Mailing address: 1499 Walton Way STE 1400, Augusta, GA 30901-2603

Registered specialties (2)

Internal Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207R00000X Licence 072627 (GA)

Other Internal Medicine providers in Georgia →

Student in an Organized Health Care Education/Training Program

Student, Health Care Taxonomy 390200000X

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Registry record

NPI: 1003115254
Entity type: Individual
Sex (as registered): Male
NPI issued: 26 Mar 2011
Record last updated: 31 May 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.