Individual
ELLISE TROUTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2310 EVERGREEN DR, ALBANY, GA 31721-5225
(229) 376-8641
Mailing address
2310 EVERGREEN DR, ALBANY, GA 31721-5225
(229) 376-8641
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
CO075513
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1744P3200X
—
GA
Enumeration date
08/12/2014
Last updated
08/12/2014
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