Individual
MR. JUSTIN D. ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1771 TATE BLVD SE, SUITE 201, HICKORY, NC 28602-4249
(828) 324-4804
(828) 324-7256
Mailing address
415 N CENTER ST, SUITE 300, HICKORY, NC 28601-5057
(828) 328-3300
(828) 328-9101
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
102909
NC
Other
Enumeration date
04/11/2006
Last updated
06/03/2015
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