Individual
DR. ELLEN EANES COURSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
604 E PARK AVE, VALDOSTA, GA 31602-3060
(229) 333-0277
(229) 241-1608
Mailing address
PO BOX 2130, VALDOSTA, GA 31604-2130
(229) 333-0277
(229) 241-1608
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
0343089
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000470533A
—
GA
01
—
062093
BLUECROSSBLUESHIELD
GA
01
—
355750
WELLCARE
GA
Enumeration date
07/23/2006
Last updated
01/18/2019
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