Jackson, Ellis R

Jackson, Ellis R is an individual health care provider with primary practice located at 610 3Rd St , Macon GA 31201-3294. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Jackson, Ellis R can be contacted via phone (229) 344-6080.

Contact Information

Primary practice address
610 3Rd St Macon GA 31201-3294
Phone: (229) 344-6080
Fax: (229) 436-8649
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X RN066377 Georgia

Profile Details

NPI number 1659362283
LBN Legal business name Jackson, Ellis R
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 2nd, 2005
Last updated Apr 12th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659362283 NPPES
Georgia MEDICAID 334081730A
Georgia Other P00220709

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