Healthcare Provider Details

I. General information

NPI: 1336192277
Provider Name (Legal Business Name): HARRIET J ELLIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 GREGG HWY
AIKEN SC
29801-6341
US

IV. Provider business mailing address

1135 GREGG HWY
AIKEN SC
29801-6341
US

V. Phone/Fax

Practice location:
  • Phone: 803-641-7700
  • Fax: 803-641-7709
Mailing address:
  • Phone: 803-641-7700
  • Fax: 803-641-7709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR00083033
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR042104
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: