Individual
DR. ELLEN DRURY FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1329 OCILLA RD, DOUGLAS, GA 31533-2213
(912) 393-0005
(912) 393-0058
Mailing address
1329 OCILLA RD, DOUGLAS, GA 31533-2213
(912) 393-0005
(912) 393-0058
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT002104
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101527
—
GA
01
—
202177960
TAX ID
GA
01
—
52144366-003
BCBS
GA
05
—
535526348B
—
GA
01
—
7298815
AETNA
GA
01
—
VGA001714
AVESIS
GA
Enumeration date
08/10/2006
Last updated
07/29/2022
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