Healthcare Provider Details

I. General information

NPI: 1871177162
Provider Name (Legal Business Name): JONATHAN GREGORY ELLIOTT HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 VICTORY BLVD STE 213
MONROE LA
71203-2006
US

IV. Provider business mailing address

201 VICTORY BLVD STE 213
MONROE LA
71203-2006
US

V. Phone/Fax

Practice location:
  • Phone: 318-350-5922
  • Fax:
Mailing address:
  • Phone: 318-350-5922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1338
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA-696
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: