Healthcare Provider Details

I. General information

NPI: 1275022907
Provider Name (Legal Business Name): MARGARET ELLIS, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2018
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: 912-349-6624
Mailing address:
  • Phone: 912-201-1619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: MARGARET ELLIS
Title or Position: MD
Credential: MD
Phone: 912-201-1619