Individual
JOSEPH DONALD ELLWANGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2440 INGLESIDE AVE, MACON, GA 31204-2088
(404) 219-4857
Mailing address
2440 INGLESIDE AVE, MACON, GA 31204-2088
(404) 219-4857
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN122302
GA
Other
Enumeration date
06/16/2021
Last updated
10/12/2021
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