Dr. Jack Bradley Ellis
Internist
1120 15th St
Augusta
, Georgia 30912
(703) 724-6100
Write a Review Share Save Call
About
Features
Language(s) Spoken
English
Ethnic Identity
White / Caucasian
Specialties
- Internist
Languages spoken
- English
Location
First Address
- Dr. Jack Bradley Ellis
- 1499 Walton Way Ste 1400
- Augusta, GA
- Zip : 30901-2603
- Phone : (703) 724-6100
Second Address
- Dr. Jack Bradley Ellis
- 1120 15th St
- Augusta, GA
- Zip : 30912
- Phone : (706) 721-8623
Reviews
FAQs
Where did Dr. Jack Bradley Ellis attend graduate school?
Provider has not completed his profile. If you are Dr. Jack Bradley Ellis, click here to claim your profile
Where did Dr. Jack Bradley Ellis do his residency?
Provider has not completed his profile. If you are Dr. Jack Bradley Ellis, click here to claim your profile
Where did Dr. Jack Bradley Ellis do his fellowship?
Provider has not completed his profile. If you are Dr. Jack Bradley Ellis, click here to claim your profile
Is Dr. Jack Bradley Ellis board certified?
Provider has not completed his profile. If you are Dr. Jack Bradley Ellis, click here to claim your profile
What type of doctor is Dr. Jack Bradley Ellis
Internist
In what state does Dr. Jack Bradley Ellis practice in?
Georgia
Where is Dr. Jack Bradley Ellis ’s practice located?
1120 15th St , Augusta, Georgia, 30912
What is Dr. Jack Bradley Ellis ’s gender?
Male
Is Dr. Jack Bradley Ellis a sole practitioner?
No
Is Dr. Jack Bradley Ellis accepting new patients?
Provider has not completed his profile. If you are Dr. Jack Bradley Ellis, click here to claim your profile
What languages does Dr. Jack Bradley Ellis speak?
Provider has not completed his profile. If you are Dr. Jack Bradley Ellis, click here to claim your profile
Does Dr. Jack Bradley Ellis accept insurance?
Yes, Dr. Jack Bradley Ellis accepts insurance
Does Dr. Jack Bradley Ellis offers telemedicine?
Dr. Jack Bradley Ellis has not indicated if he offers telemedicine
What is Dr. Jack Bradley Ellis ’s professional license number?
Provider has not completed his profile. If you are Dr. Jack Bradley Ellis, click here to claim your profile
What is Dr. Jack Bradley Ellis ’s NPI number?
1003115254
Does Dr. Jack Bradley Ellis have any license restrictions?
Provider has not completed his profile. If you are Dr. Jack Bradley Ellis, click here to claim your profile
Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207R00000X | Internist | 072627 | GA |
| Y | 111NI0900X | Internist | 072627 | GA |
National Provider Identifier
| NPI | 1003115254 |
|---|---|
| Provider Name | Dr. Jack Bradley Ellis |
| First Address | Augusta, GA 30901-2603 |
| Second Address | Augusta, GA 30912 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 26/03/2011 |
| Last Update Date | 31/05/2018 |
NPI Footnotes
What is the National Provider Identifier (NPI)
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
Entity Type Code
The code describing the type of health care provider that is being assigned an NPI. The entity type codes are:
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers.
Subpart examples include: Hospital components include outpatient departments, surgical centers,
psychiatric units, and laboratories. These components are often separately licensed or certified by
States and may exist at physical locations other than that of the hospital of which they are a
component.
Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if
an individual) or other name by which the organization provider is or has been known. The code
identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.
Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date
The date that a NPI record was last updated or changed
Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPls the license data is associated to the taxonomy code.
Authorized Official Name
The name of the person authorized to submit the PI application or to officially change data for a health care provider.