Individual
DR. REUBEN KRISTIAN ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1425 GEORGIA AVE STE 201A, MACON, GA 31201-6546
(478) 250-1325
Mailing address
PO BOX 6612, MACON, GA 31208-6612
(478) 250-1325
(478) 254-6860
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
055819
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
730346684AA
—
GA
05
—
730346684AB
—
GA
05
—
730346684AC
—
GA
05
—
730346684AD
—
GA
05
—
730346684G
—
GA
05
—
730346684J
—
GA
05
—
730346684K
—
GA
05
—
730346684M
—
GA
05
—
730346684N
—
GA
05
—
730346684O
—
GA
05
—
730346684P
—
GA
05
—
730346684Q
—
GA
05
—
730346684R
—
GA
05
—
730346684S
—
GA
05
—
730346684T
—
GA
05
—
730346684U
—
GA
05
—
730346684V
—
GA
05
—
730346684W
—
GA
05
—
730346684X
—
GA
05
—
730346684Y
—
GA
05
—
730346684Z
—
GA
Enumeration date
06/12/2006
Last updated
11/19/2020
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