Individual
DOUGLAS WILLIAM ELLENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1330 INTERSTATE PKWY, AUGUSTA, GA 30909-5625
(706) 651-2020
(706) 651-2032
Mailing address
1330 INTERSTATE PKWY, AUGUSTA, GA 30909-5625
(706) 651-2020
(706) 651-2032
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT002659
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013147572A
—
GA
Enumeration date
07/14/2011
Last updated
03/14/2016
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