Individual
MARK A ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1765 OLD WEST BROAD ST, BLDG 1 STE 200, ATHENS, GA 30606-2867
(706) 208-0451
(706) 208-0147
Mailing address
PO BOX 7577, ATHENS, GA 30604-7577
(706) 208-0451
(706) 208-0147
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
036525
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000526479B
—
GA
Enumeration date
02/01/2006
Last updated
08/21/2012
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