Organization
PHYSICIAN CONSULTANTS OF GEORGIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REUBEN KRISTIAN ELLIS MD (OWNER/PHYSICIAN)
(404) 877-8115
Entity
Organization
Contact information
Practice address
1425 GEORGIA AVE STE 201A, MACON, GA 31201-6546
(478) 250-1325
Mailing address
PO BOX 6612, MACON, GA 31208-6612
(478) 250-1325
(478) 254-6860
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
055819
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003126259A
—
GA
Enumeration date
05/28/2012
Last updated
11/19/2020
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