Jeanna Ellis
Individual provider Active NPI Pharmacist · Jefferson, GA
NPI 1780835876 · NPPES record last updated Dec 26, 2022
Key facts
- NPI
- 1780835876
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RPH024387 (GA)
- Practice address
- 1305 Washington St.
Jefferson, GA 30549 - Phone
- (706) 367-8828
- NPI assigned
- Oct 7, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH024387 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current |
Accepting new patients | |
| Walgreen Co | Past |
Accepting new patients |
Locations
319 S Broad St
Monroe, GA 30655
Phone (770) 266-6061
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH024387 | GA | Yes |
Addresses
Primary practice location
1305 Washington St.
Jefferson, GA 30549
Mailing address
319 S Broad St
Monroe, GA 30655-2119
Phone (770) 266-6061
Other names
- Dr. Jeanna Ellis
Other providers in Jefferson, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 26, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.