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General NPI Number Information
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NPI Number | 1871177162
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Entity Type | Individual
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Provider Name | JONATHAN GREGORY ELLIOTT HIS
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Gender | Male
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Dates
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Enumeration Date | 05/12/2021
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 201 VICTORY BLVD STE 213
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City | MONROE
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State | LA
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Zip | 71203-2006
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Country | US
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Telephone | 318-350-5922
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Fax |
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Provider Business Mailing Address
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Address Line | 201 VICTORY BLVD STE 213
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City | MONROE
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State | LA
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Zip | 71203-2006
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Country | US
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Telephone | 318-350-5922
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 1338
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HA-696
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License Number State | MS
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