John F. Ellenberg, M.D., P.C.

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

021451 Issued in GA

Legal business name

JOHN F. ELLENBERG, M.D., P.C.

Practice address

2500 Starling St
406
Brunswick, GA 31520-4265

Phone

(912) 261-0447

Fax

(912) 261-1847

NPI assigned

Oct 21, 2010

Last updated

Oct 21, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. John F. Ellenberg, M.D.

Title

President

Phone

(912) 261-0447

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1287619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287619200000",
    "number": "1376853507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 STARLING ST",
            "address_2": "406",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204265",
            "telephone_number": "912-261-0447",
            "fax_number": "912-261-1847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 STARLING ST",
            "address_2": "406",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204265",
            "telephone_number": "912-261-0447",
            "fax_number": "912-261-1847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN F. ELLENBERG, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-21",
        "last_updated": "2010-10-21",
        "status": "A",
        "authorized_official_last_name": "ELLENBERG",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "912-261-0447",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "GA",
            "license": "021451",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000384315A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gynecology Physician in Brunswick, GA
• Providers in Brunswick, GA by specialty
• Gynecology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.