Shannon Bolling Ellis, D.O.
Individual provider Active NPI Public Health & General Preventive Medicine Physician · Savannah, GA
NPI 1295706166 · NPPES record last updated Jan 25, 2021
Key facts
- NPI
- 1295706166
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Public Health & General Preventive Medicine Physician 2083P0901X
- License
- 073702 (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
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110106001192 | GA | Practitioner - Preventive Medicine | 7113116070 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chatham County Board of Health | Current |
Accepting new patients | |
| Glynn County Board of Health | Current |
Accepting new patients | |
| Liberty County Board of Health | Current |
Accepting new patients | |
| Chatham County Board of Health | Current |
Accepting new patients | |
| Fci Jesup | Past |
Accepting new patients |
Locations
150 Scranton Connector
Brunswick, GA 31525
Phone (912) 262-2300
2747 4th St
Brunswick, GA 31520
Phone (912) 262-2347
1113 E Oglethorpe Hwy
Hinesville, GA 31313
Phone (912) 280-7023
107 Fahm St
#B
Savannah, GA 31401
Phone (912) 651-2253
1395 Eisenhower Dr
Savannah, GA 31406
Phone (912) 356-2157
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health & General Preventive Medicine Physician | 2083P0901X | 073702 | GA | Yes |
Addresses
Primary practice location
400 Mall Blvd Ste G
Savannah, GA 31406-4820
Mailing address
815 Oak Landing Rd
Jesup, GA 31546-1518
Phone (912) 424-2925
Other providers in Savannah, GA
- Elisha Ellis
- Haley M Ellis
- Keith Errett Ellis
- Margaret Ann Ellis
- Morgan Taylor Ellis
- Stephanie Rachel Ellis
- Stephanie Rene Ellis
- Gregory Taylor Ellison Jr.
- Nancy Halligan Ellison
- Natasha L Ellison
All providers in Savannah, GA · Public Health & General Preventive Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 25, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.