Healthcare Provider Details

I. General information

NPI: 1700828613
Provider Name (Legal Business Name): GEORGE S. ELLIS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVE SUITE 3106
NEW ORLEANS LA
70118-5720
US

IV. Provider business mailing address

200 HENRY CLAY AVE SUITE 3106
NEW ORLEANS LA
70118-5720
US

V. Phone/Fax

Practice location:
  • Phone: 504-896-9426
  • Fax: 504-896-9312
Mailing address:
  • Phone: 504-896-9426
  • Fax: 504-896-9312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number014253
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number014253
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: