Individual
ANTHONY FORREST ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
808 WARD ST W, DOUGLAS, GA 31533-3514
(912) 383-0559
(912) 383-0614
Mailing address
PO BOX 2150, TIFTON, GA 31793-2150
(912) 383-0559
(912) 383-0614
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 001108
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000278429D
—
GA
05
—
000278429F
—
GA
05
—
000278429G
—
GA
Enumeration date
08/08/2006
Last updated
09/07/2010
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