Individual
MR. CARL EDWARD ELLIS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
700 CITY HALL DR, FORT OGLETHORPE, GA 30742-7802
(706) 861-3387
(706) 861-3332
Mailing address
31 S GLADE RD, FORT OGLETHORPE, GA 30742-3909
(706) 866-5097
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
RPH009402
GA
Other
Enumeration date
03/19/2007
Last updated
07/08/2007
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