Shannon Bolling Ellis, D.O.

Primary specialty

Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X

License

073702 Issued in GA

Practice address

400 Mall Blvd Ste G
Savannah, GA 31406-4820

Phone

(912) 644-5200

Fax

(912) 349-5691

NPI assigned

Jan 30, 2006

Last updated

Jan 25, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Chatham County Board of Health

  dba Chatham County Health Department-IDC

  • Public Health or Welfare Agency
  • Savannah, GA
  • NPI 1164503124
  Medicare reassignment NPD
• Glynn County Board of Health

  dba Coastal Health District-Brunswick

  • Public Health or Welfare Agency
  • Brunswick, GA
  • NPI 1164429692
  Medicare reassignment NPD
• Chatham County Board of Health

  dba Chatham County Health Department

  • Public Health or Welfare Agency
  • Savannah, GA
  • NPI 1275618407
  NPD
• Liberty County Board of Health

  dba Liberty County Health Department

  • Public Health or Welfare Agency
  • Hinesville, GA
  • NPI 1245546704
  NPD
• Fci Jesup

  • Prison Health Clinic/Center
  • Jesup, GA
  • NPI 1508538679
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611532800000",
    "number": "1295706166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 OAK LANDING RD",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315461518",
            "telephone_number": "912-424-2925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MALL BLVD STE G",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314064820",
            "telephone_number": "912-644-5200",
            "fax_number": "912-349-5691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "SHANNON",
        "middle_name": "BOLLING",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "GA",
            "license": "073702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elisha Ellis, RBT
• Haley M Ellis, CRNA
• Keith Errett Ellis, M.D.
• Margaret Ann Ellis, M.D.
• Morgan Taylor Ellis
• Stephanie Rachel Ellis, PHARM.D.
• Stephanie Rene Ellis, RBT
• Gregory Taylor Ellison Jr., M.D.
• Nancy Halligan Ellison, PA
• Natasha L Ellison

• Public Health & General Preventive Medicine Physician in Savannah, GA
• Providers in Savannah, GA by specialty
• Public Health & General Preventive Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.