Individual
DR. RUSSELL JOHN ELLICOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
501 FURYS FERRY RD, MARTINEZ, GA 30907-9059
(706) 738-3298
(706) 364-4290
Mailing address
501 FURY'S FERRY ROAD, MARTINEZ, GA 30907
(706) 738-3298
(706) 364-4290
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
96
SC
213E00000X
Podiatrist
Primary
POD000558
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00336124A
—
GA
Enumeration date
06/15/2006
Last updated
02/06/2019
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