Individual
RICHARD L ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
175 EMERY HWY, MACON, GA 31217-3692
(478) 803-7600
(478) 803-8596
Mailing address
175 EMERY HWY, MACON, GA 31217-3692
(478) 803-7631
(478) 803-8596
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
029634
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000380179D
—
GA
01
—
029634
GEORGIA LICENSE
GA
01
—
260027763
RAILROAD MEDICARE
GA
Enumeration date
10/26/2006
Last updated
07/21/2022
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