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General NPI Number Information
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NPI Number | 1871591297
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Entity Type | Individual
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Provider Name | MARGARETT CONKLIN ELLISON M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/10/2005
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 3131 S MAIN ST
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City | MOULTRIE
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State | GA
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Zip | 31768-6925
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Country | US
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Telephone | 229-890-3514
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2876
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City | MOULTRIE
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State | GA
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Zip | 31776-2876
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Country | US
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Telephone | 229-890-3514
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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 | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 62837
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | ME128607
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License Number State | FL
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