Provider Demographics
NPI:1497792154
Name:ELLIS, JANE E (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:E
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:80 JESSE HILL JR DR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3031
Mailing Address - Country:US
Mailing Address - Phone:404-616-4646
Mailing Address - Fax:404-521-3589
Practice Address - Street 1:80 JESSE HILL JR DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3031
Practice Address - Country:US
Practice Address - Phone:404-616-4646
Practice Address - Fax:404-521-3589
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2009-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA044208207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI32118Medicare UPIN