Individual
RICHARD S ELLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
455 PHILIP BLVD STE 130, KAISER PERMANENTE LAWRENCEVILLE MEDICAL OFFICE, LAWRENCEVILLE, GA 30046-8768
(678) 985-5000
(828) 526-2914
Mailing address
3495 PIEDMONT RD NE, NINE PIEDMONT CENTER, ATLANTA, GA 30305-1717
(404) 504-5678
(828) 526-1285
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
025604
GA
207R00000X
Internal Medicine Physician
2016-01385
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NCT328A194
MEDICARE PTAN
NC
Enumeration date
08/14/2006
Last updated
01/06/2022
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