Provider Demographics
NPI:1891378683
Name:ELLIS, BRITNEY MAE (NP-C)
Entity Type:Individual
Prefix:
First Name:BRITNEY
Middle Name:MAE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 CANAL ST STE 503
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4261
Mailing Address - Country:US
Mailing Address - Phone:912-450-6300
Mailing Address - Fax:912-450-6303
Practice Address - Street 1:114 CANAL ST STE 503
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4261
Practice Address - Country:US
Practice Address - Phone:912-450-6300
Practice Address - Fax:912-450-6303
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN237101363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily