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General NPI Number Information
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NPI Number | 1104130574
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Entity Type | Individual
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Provider Name | RYAN SCOTT ELLSWORTH DPM
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Gender | Male
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Dates
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Enumeration Date | 07/28/2010
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 505 FAIRBURN RD SW STE 100
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City | ATLANTA
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State | GA
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Zip | 30331-2012
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Country | US
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Telephone | 404-618-6077
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Fax | 801-253-6888
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Provider Business Mailing Address
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Address Line | 9980 S 300 W STE 300
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City | SANDY
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State | UT
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Zip | 84070-3654
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Country | US
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Telephone | 801-273-0001
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Fax | 801-253-6888
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 2109
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E5797
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO4406
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | POD001473
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 8400193-0501
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License Number State | UT
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Taxonomy #6
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Taxonomy Code | 213ER0200X
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Taxonomy Name | Radiology Podiatrist
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License Number | 8400193-0501
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License Number State | UT
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Taxonomy #7
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Taxonomy Code | 213ES0000X
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Taxonomy Name | Sports Medicine Podiatrist
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License Number | 8400193-0501
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License Number State | UT
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Taxonomy #8
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 8400193-0501
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License Number State | UT
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Taxonomy #9
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 8400193-0501
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License Number State | UT
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