Healthcare Provider Details

I. General information

NPI: 1437514031
Provider Name (Legal Business Name): DR. JAMES ALEC ELLISON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CLIFTON RD NE MAILSTOP G33
ATLANTA GA
30329-4018
US

IV. Provider business mailing address

1600 CLIFTON RD NE MAILSTOP G33
ATLANTA GA
30329-4018
US

V. Phone/Fax

Practice location:
  • Phone: 404-639-2693
  • Fax:
Mailing address:
  • Phone: 404-639-2693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246QM0900X
TaxonomyMicrobiology Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: