Individual
ELLIS LAMAR WYNN IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1139 PICKET FENCE DR, EVANS, GA 30809-9158
(229) 854-9517
Mailing address
1636 S CASTLE STONE SQ, BILLINGS, MT 59106-9724
(229) 854-9517
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN286537
GA
367500000X
Certified Registered Nurse Anesthetist
Primary
267591
MT
Other
Enumeration date
07/31/2024
Last updated
02/03/2026
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