Jennifer Hicks Ellerbe, MS
Individual provider Active NPI Other Technician · Grayson, GA
NPI 1841007283 · NPPES record last updated Dec 17, 2024
Key facts
- NPI
- 1841007283
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Other Technician 247200000X
- License
- 199759 (GA)
- Practice address
- 1344 Swallows Walk
Grayson, GA 30017-1736 - Phone
- (770) 364-2623
- NPI assigned
- Dec 17, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 199759 | GA | MD | Other Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | 199759 | GA | Yes |
Addresses
Primary practice location
1344 Swallows Walk
Grayson, GA 30017-1736
Mailing address
1344 Swallows Walk
Grayson, GA 30017-1736
Phone (770) 364-2623
Other providers in Grayson, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2024. 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.