Jackie Dwayne Ellington, EMT

Primary specialty

Intermediate Emergency Medical TechnicianTaxonomy code 146M00000X

License

28696 Issued in GA

Practice address

1548 Old Hwy 5 South
Ellijay, GA 30540

Phone

(706) 273-7477

Fax

(706) 276-8474

NPI assigned

Sep 18, 2012

Last updated

Sep 18, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Emergency Medical Technician

State licenses

Practice roles

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.

• Hope Ambulance LLC

  • Land Ambulance
  • Ellijay, GA
  • NPI 1033469192
  NPD (past) Authorized official
• Tri-County Ambulance Service

  • Land Ambulance
  • Ellijay, GA
  • NPI 1346340643
  NPD (past) Authorized official
• Southland Health Services of Georgia, Inc.

  • Ambulance
  • Ellijay, GA
  • NPI 1720292584
  NPD (past)

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

{
    "created_epoch": "1347926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347926400000",
    "number": "1841540754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1725",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305400033",
            "telephone_number": "706-273-7477",
            "fax_number": "706-276-8474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1548 OLD HWY 5 SOUTH",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "30540",
            "telephone_number": "706-273-7477",
            "fax_number": "706-276-8474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGTON",
        "first_name": "JACKIE",
        "middle_name": "DWAYNE",
        "credential": "EMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-09-18",
        "last_updated": "2012-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146M00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Intermediate",
            "state": "GA",
            "license": "28696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dietary Apothecary Inc.
• Michael R Doucette Jr., LDO
• Draneco Inc (Ellijays Bestrx)
• Bradleigh Dyer-McPherson, FNP
• Ellijay Center for Change, PC
• Stacey Lynne Evans-Paulin, PA-C
• Family Life Chiropractic Center III
• Robert Stephen Feldman, MD
• Marissa Lee Fidler, PA-C
• D'Wayne Fowler, DDS

• Intermediate Emergency Medical Technician in Ellijay, GA
• Providers in Ellijay, GA by specialty
• Intermediate Emergency Medical Technician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2012; 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.