Individual
JOHNNY R. ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1051 4TH AVE, GALLIPOLIS, OH 45631-1612
(740) 446-5244
(740) 446-5625
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5000
(740) 446-5625
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34-00-3700
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000007522
ANTHEM BCBS
—
01
—
000000181981
UNISON MEDICAID
OH
01
—
001714065
MOUNTAIN STATE BCBS
—
05
—
0051040000
—
WV
01
—
0555340
MOLINA MEDICAID
OH
05
—
0555340
—
OH
01
—
080056559
RR MEDICARE
—
01
—
310917085105
CARESOURCE MEDICAID
OH
Enumeration date
05/23/2006
Last updated
08/23/2022
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