Provider Demographics
NPI:1639950173
Name:MAFFEO, ELLEN LOUISE (PA-C)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:LOUISE
Last Name:MAFFEO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4688 SAVAGE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2324
Mailing Address - Country:US
Mailing Address - Phone:478-718-1844
Mailing Address - Fax:
Practice Address - Street 1:4688 SAVAGE HILLS DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2324
Practice Address - Country:US
Practice Address - Phone:478-718-1844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography