Individual
ELLISON ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1657 TRINITY DR, PENSACOLA, FL 32504-5708
(850) 416-2400
(850) 416-2330
Mailing address
1501 TATE BLVD SE STE 201, HICKORY, NC 28602-1385
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
2024-00280
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/18/2020
Last updated
04/23/2024
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