Provider Demographics
NPI:1194951764
Name:ELLIS, MARGARET ANN (MD)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:ANN
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARGARET
Other - Middle Name:ELLIS
Other - Last Name:MCKENNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:310 EISENHOWER DRIVE
Mailing Address - Street 2:BUILDING 5
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406
Mailing Address - Country:US
Mailing Address - Phone:912-201-1619
Mailing Address - Fax:
Practice Address - Street 1:310 EISENHOWER DRIVE
Practice Address - Street 2:BUILDING 5
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:912-201-1619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC316922080P0006X
GA0466202080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003125717CMedicaid
GA003205914AMedicaid
GA202I372079Medicare PIN
GA202I372079Medicare PIN