Provider Demographics
NPI:1942037056
Name:ELLIS, SARAH GREEN (ND)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:GREEN
Last Name:ELLIS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 SANDERS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-7903
Mailing Address - Country:US
Mailing Address - Phone:843-501-2333
Mailing Address - Fax:
Practice Address - Street 1:1941 SAVAGE RD STE 100E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4788
Practice Address - Country:US
Practice Address - Phone:843-501-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0155175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath