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General NPI Number Information
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NPI Number | 1134292766
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Entity Type | Individual
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Provider Name | RUSSELL L ELLIS MD
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Gender | Male
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 1103 16TH AVE SE
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City | DECATUR
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State | AL
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Zip | 35601-3595
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Country | US
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Telephone | 256-350-0362
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Fax |
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Provider Business Mailing Address
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Address Line | 1107 14TH AVE SE STE 300
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City | DECATUR
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State | AL
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Zip | 35601-3368
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Country | US
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Telephone | 256-350-0362
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Fax |
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 00022020
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License Number State | AL
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