Active NPI
John Ellis IV
- Pharmacist
- Newnan, GA
National Provider Identifier
1063013613
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH024504
- Practice address
- 135 Rudders Xing
Newnan, GA 30263-7032 - Phone
- (678) 994-2192
- NPI assigned
- Nov 2, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH024504 | GA | Primary |
Addresses
Primary practice location
135 Rudders Xing
Newnan, GA 30263-7032
Mailing address
135 Rudders Xing
Newnan, GA 30263-7032
Phone (678) 994-2192
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH024504 | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604275200000",
"number": "1063013613",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "135 RUDDERS XING",
"city": "NEWNAN",
"state": "GA",
"postal_code": "302637032",
"telephone_number": "678-994-2192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "135 RUDDERS XING",
"city": "NEWNAN",
"state": "GA",
"postal_code": "302637032",
"telephone_number": "678-994-2192"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "JOHN",
"name_suffix": "IV",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-02",
"last_updated": "2020-11-02",
"certification_date": "2020-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH024504",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newnan, GA
- Elevate Behavioral Health and Wellness LLC
- Elite Medical Care and Weight Loss Center, LLC
- Noel Rose Elkareh
- Tristina Marie Ellenburg, MS, BCBA, COBA, LBA
- William Kerry Elliott, DC
- Kylie Alyssa Ellis, APRN
- Emeritus Corporation (Brookdale Newnan)
- Empyrean Hospice of Georgia, LLC
- Enti Anesthesia, LLC
- Enti Surgery Center LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.