Individual
MR. LELAND CALVIN ELLIS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
324A BEACON DR, WINTERVILLE, NC 28590-7956
(252) 551-5595
(252) 321-7762
Mailing address
4076 MOBLEYS BRIDGE RD, GRIMESLAND, NC 27837-8999
(252) 752-5811
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
103962
NC
Other
Enumeration date
09/13/2006
Last updated
06/03/2008
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