Jared S Ellis, MD
Family Medicine in Tuscaloosa, AL. Individual provider (NPI-1).
NPI number1790785756
StatusActive
Last updated in NPPESSep 1, 2022
Details
- NPI
- 1790785756
- Entity type
- Individual (NPI-1)
- Name
- Jared S Ellis
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 29, 2005
- Certification date
- Sep 1, 2022
- Last updated
- Sep 1, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 17418 | AL | Yes |
Practice location
2201 Jack Warner PkwyTuscaloosa, AL 35401-1090
Phone 205-523-5618
Mailing address
2201 Jack Warner PkwyTuscaloosa, AL 35401-1090
Phone 205-523-5618
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