Healthcare Provider Details

I. General information

NPI: 1194951764
Provider Name (Legal Business Name): MARGARET ANN ELLIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARGARET ELLIS MCKENNA M.D.

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 EISENHOWER DRIVE BUILDING 5
SAVANNAH GA
31406
US

IV. Provider business mailing address

310 EISENHOWER DRIVE BUILDING 5
SAVANNAH GA
31406
US

V. Phone/Fax

Practice location:
  • Phone: 912-201-1619
  • Fax:
Mailing address:
  • Phone: 912-201-1619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number31692
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number046620
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: