DR. Jack Bradley Ellis, D.O.

NPI #1003115254 in Augusta, Georgia

Provider Information

NPI Number: 1003115254
Entity Type: Individual
Name: DR. Jack Bradley Ellis, D.O.
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Internal Medicine
Credential: D.O.
Enumeration Date: Mar 26, 2011
Last Updated: May 31, 2018

Practice Location

Address: 1120 15TH ST
City: Augusta
State: Georgia
ZIP Code: 30912
Phone: (706) 721-8623

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Student in an Organized Health Care Education/Training Program	390200000X
Internal Medicine	207R00000X	Primary

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