# MARK A ELLIS, MD, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ELLIS PAIN MANAGEMENT
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841261294
- **Authorized official:** DR. MARK A ELLIS MD (PRESIDENT)
- **Authorized official phone:** (706) 208-0451

## Contact information

- **Practice address:** 1500 LANGFORD MEDICAL DRIVE, SUITE 200, BOGART, GA 30622-6220
- **Practice address phone:** (706) 208-0451
- **Practice address fax:** (706) 208-0147
- **Mailing address:** PO BOX 7577, ATHENS, GA 30604-7577
- **Mailing address phone:** (706) 208-0451
- **Mailing address fax:** (706) 208-0147

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | GA | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | GA | Yes |

## Other

- **Enumeration date:** 02/01/2006
- **Last updated:** 07/21/2022