Individual
JULIA CENTANNI ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
411 N SECTION ST, FAIRHOPE, AL 36532-2649
(251) 660-3470
(251) 660-3471
Mailing address
6701 AIRPORT BLVD STE D143, MOBILE, AL 36608-6701
(251) 342-3949
(251) 266-3361
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO850
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810005825
—
WV
01
—
51119080
BC
AL
01
—
DO850
MEDICAL LICENSE
AL
Enumeration date
05/17/2006
Last updated
01/31/2020
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