Organization
GREGORY T. ELLISON, M.D.,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY T ELLISON M.D. (PRESIDENT)
(706) 724-5451
Entity
Organization
Contact information
Practice address
1430 B HARPER STREET, AUGUSTA, GA 30901
(706) 724-5451
(706) 724-9562
Mailing address
1430 B HARPER STREET, AUGUSTA, GA 30901
(706) 724-5451
(706) 724-9562
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
024806
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00325949C
—
GA
05
—
GPA817
—
SC
Enumeration date
10/03/2006
Last updated
10/21/2016
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