JACK ELLIS — Medicare Enrolled Provider (PRACTITIONER - INTERNAL MEDICINE, GA)
JACK ELLIS — Medicare Enrolled Provider (PRACTITIONER - INTERNAL MEDICINE, GA) is one of 9,000 enrolled providers in the MedicareEnroll dataset. Key details — Name: JACK ELLIS; Type: Individual; NPI: 1003115254.
| Name | JACK ELLIS |
|---|---|
| Type | Individual |
| NPI | 1003115254 |
| Provider type | PRACTITIONER - INTERNAL MEDICINE |
| State | GA |
| Enrollment ID | I20150317001692 |
| Multiple NPI flag | N |
| Source | CMS Medicare FFS Public Provider Enrollment (PECOS) |
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