Provider Demographics
NPI:1124586623
Name:ELLIS-GEORGE, JOY A (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:A
Last Name:ELLIS-GEORGE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 N CAPITOL ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3396
Mailing Address - Country:US
Mailing Address - Phone:202-745-0073
Mailing Address - Fax:
Practice Address - Street 1:1400 MERCANTILE LN STE 252
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5333
Practice Address - Country:US
Practice Address - Phone:844-200-3273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1033878363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health