Provider Demographics
NPI:1417373986
Name:EBBERT, JANA (DO)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:EBBERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S WELLS ST
Mailing Address - Street 2:
Mailing Address - City:SISTERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26175-1098
Mailing Address - Country:US
Mailing Address - Phone:304-652-2611
Mailing Address - Fax:
Practice Address - Street 1:999 CHERAW ST
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-2420
Practice Address - Country:US
Practice Address - Phone:843-479-2341
Practice Address - Fax:843-479-2346
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-08
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS25215207Q00000X
WV3393207Q00000X
SC81620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty