Individual
LOGAN WILLIAM ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 PATEWOOD DR STE C300, GREENVILLE, SC 29615-6324
(864) 908-0122
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(803) 434-1335
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1175810
NCCPA
—
Enumeration date
01/04/2021
Last updated
08/10/2021
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