Individual
MICHAEL ALAN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2000 16TH AVENUE, COLUMBUS, GA 31901-1665
(706) 320-3770
(706) 320-3772
Mailing address
2300 MANCHESTER EXPY STE 2001A, COLUMBUS, GA 31904-6802
(706) 320-3126
(706) 320-3054
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
062835
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112485
—
AL
05
—
216425865A
—
GA
Enumeration date
11/21/2006
Last updated
08/01/2024
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