Healthcare Provider Details

I. General information

NPI: 1225250285
Provider Name (Legal Business Name): HALEY M ELLIS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 EISENHOWER DR BUILDING 12 SUITE B
SAVANNAH GA
31406-2632
US

IV. Provider business mailing address

PO BOX 933642
ATLANTA GA
31193-0001
US

V. Phone/Fax

Practice location:
  • Phone: 912-354-3510
  • Fax: 912-356-3391
Mailing address:
  • Phone: 912-354-3510
  • Fax: 912-356-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3175
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN157564
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: