Individual
DR. ELLIOTT JOHN SALLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1050 JABARA AVE, SJAFB, PEDIATRIC CLINIC, GOLDSBORO, NC 27531-2310
(919) 722-1536
Mailing address
5213 S ALSTON AVE, DURHAM, NC 27713-4430
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0102204044
VA
208000000X
Pediatrics Physician
Primary
2020-02658
NC
Other
Enumeration date
02/15/2012
Last updated
08/20/2020
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