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General NPI Number Information
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NPI Number | 1073708251
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Entity Type | Organization
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Legal Business Name | GEORGE G ELLIS JR MD INC
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 910 BOARDMAN CANFIELD RD
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City | BOARDMAN
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State | OH
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Zip | 44512-4240
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Country | US
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Telephone | 330-965-0832
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Fax | 330-965-0155
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Provider Business Mailing Address
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Address Line | 910 BOARDMAN CANFIELD RD
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City | BOARDMAN
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State | OH
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Zip | 44512-4240
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Country | US
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Telephone | 330-965-0832
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Fax | 330-965-0155
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. LORRAINE ELLIS
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Credential |
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Telephone | 330-965-0832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35060641E
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License Number State | OH
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