Healthcare Provider Details

I. General information

NPI: 1417373986
Provider Name (Legal Business Name): JANA EBBERT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2014
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 CHERAW ST
BENNETTSVILLE SC
29512-2420
US

IV. Provider business mailing address

314 S WELLS ST
SISTERSVILLE WV
26175-1098
US

V. Phone/Fax

Practice location:
  • Phone: 843-479-2341
  • Fax: 843-479-2346
Mailing address:
  • Phone: 304-652-2611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3393
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25215
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number81620
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: