Organization
DAVID J. ELLIS, DO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID J ELLIS DO (PHYSICIAN)
(912) 375-7575
Entity
Organization
Contact information
Practice address
143 S TALLAHASSEE ST, HAZLEHURST, GA 31539-6466
(912) 375-7575
(912) 375-7553
Mailing address
PO BOX 4207, MACON, GA 31208-4207
(912) 375-7575
(912) 375-7553
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
020865
GA
Other
Enumeration date
01/22/2007
Last updated
08/20/2009
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