Individual
MICAH RANDAL ELLOWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
9164 DR M L KING JR AVE, COVINGTON, GA 30014-8710
(770) 784-7030
Mailing address
2426 S MAIN ST, RED BLUFF, CA 96080-4337
(530) 527-6777
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
108894
CA
1223G0001X
General Practice Dentistry
Primary
DN123691
GA
Other
Enumeration date
06/27/2023
Last updated
09/16/2025
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