MEDICARE: JOY A ELLIS-GEORGE PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN1033878	DC

General Provider Information

NPI Number	:	1124586623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOY A ELLIS-GEORGE PMHNP-BC

Provider Business Mailing Address
First Line	:	1338 N CAPITOL ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-3396
Country	:	US
Telephone Number	:	202-745-0073
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 MERCANTILE LN STE 252
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-5333
Country	:	US
Telephone Number	:	844-200-3273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2019
Last Update Date	:	09/11/2019

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