Provider Demographics
NPI:1730319260
Name:ELLIS-JOHNSON, GALE ELAINE (RN)
Entity type:Individual
Prefix:MS
First Name:GALE
Middle Name:ELAINE
Last Name:ELLIS-JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 ELLIS RD
Mailing Address - Street 2:
Mailing Address - City:HOGANSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30230-4014
Mailing Address - Country:US
Mailing Address - Phone:706-672-1016
Mailing Address - Fax:
Practice Address - Street 1:3855 PRESIDENTIAL PKWY
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30340-3705
Practice Address - Country:US
Practice Address - Phone:770-451-6838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN058893163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health