Provider Demographics
NPI:1215507850
Name:ELLIS, BOBBIE RENA (CNA)
Entity type:Individual
Prefix:
First Name:BOBBIE
Middle Name:RENA
Last Name:ELLIS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1178 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:GA
Mailing Address - Zip Code:31064-2111
Mailing Address - Country:US
Mailing Address - Phone:762-435-7123
Mailing Address - Fax:
Practice Address - Street 1:1178 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:GA
Practice Address - Zip Code:31064-2111
Practice Address - Country:US
Practice Address - Phone:762-435-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-27
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide