Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Jack Bradley Ellis, DO

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1003115254

Dr. Jack Bradley Ellis, DO is an Internal Medicine in Augusta, Georgia. Qualified in 2011, 15 years ago. Practices with Wellstar Medical Group LLC, a 3,072-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
15
Licensed in
GA
In the registry since
2011
Specialties on file
2
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

1120 15th St
Augusta, GA 30912
Phone: (706) 721-8623
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 9040 Fitzsimmons Dr, Joint Base Lewis McChord, WA 98431-1000 — (253) 968-0208

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence 072627 (GA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1003115254
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedMarch 26, 2011
Last updated in NPPESMay 31, 2018
Mailing address1499 Walton Way Ste 1400, Augusta, GA 30901-2603

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Group practice Wellstar Medical Group Llc — 3072 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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