Individual
DR. WENDELL K ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
682 HEMLOCK STREET, SUITE 490, MACON, GA 31201
(478) 741-1208
(478) 741-1557
Mailing address
682 HEMLOCK ST, STE 490, MACON, GA 31201
(478) 741-1208
(478) 741-1557
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
062202
GA
207RC0000X
Cardiovascular Disease Physician
Primary
062202
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
795311786B
—
GA
Enumeration date
12/11/2006
Last updated
03/13/2015
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