Individual
RUSSELL L ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1103 16TH AVE SE, DECATUR, AL 35601-3595
(256) 350-0362
Mailing address
1107 14TH AVE SE STE 300, DECATUR, AL 35601-3368
(256) 350-0362
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
00022020
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009983450
—
AL
01
—
260050183
RAILROAD MEDICARE
—
01
—
51507394
BLUECROSS BLUESHIELD OF A
AL
Enumeration date
11/15/2006
Last updated
07/30/2025
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