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General NPI Number Information
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NPI Number | 1033448311
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Entity Type | Organization
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Legal Business Name | THE ELLIS GROUP
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Dates
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Enumeration Date | 12/15/2009
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Last Update Date | 12/15/2009
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Provider Practice Location Address
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Address Line | 724 S 8TH ST
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City | GRIFFIN
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State | GA
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Zip | 30224-4827
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Country | US
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Telephone | 770-227-3514
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Fax | 770-229-6059
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Provider Business Mailing Address
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Address Line | 724 S 8TH ST
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City | GRIFFIN
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State | GA
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Zip | 30224-4827
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Country | US
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Telephone | 770-227-3514
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Fax | 770-229-6059
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Authorized Official
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Title or Position | OWNER
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Name | DR. TONY NICHOLAS
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Credential | D.C.
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Telephone | 770-227-3514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4951
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License Number State | GA
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