Individual
DR. JUSTIN DANIEL ELLETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
2687 LAKE PARK DRIVE, N CHARLESTON, SC 29406
(843) 572-1010
(843) 569-1719
Mailing address
641 SAINT ANDREWS BLVD, CHARLESTON, SC 29407-7165
(843) 766-4070
(843) 766-0633
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
33598
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275827248
MEDCOST
SC
05
—
335989
—
SC
Enumeration date
06/07/2011
Last updated
02/17/2017
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