Individual
DR. MARK ANDREW ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 E WOOD ST, SPARTANBURG, SC 29303-3040
(864) 560-7025
(864) 560-7388
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
33112
SC
207P00000X
Emergency Medicine Physician
A108778
CA
207P00000X
Emergency Medicine Physician
TL33112
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
331126
—
SC
05
—
5917294
—
NC
Enumeration date
10/02/2008
Last updated
12/28/2020
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