MEDICARE: DR. MILES WAYNE ELLIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	039782	GA
2	207P00000X	Emergency Medicine Physician	27642	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871510644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MILES WAYNE ELLIS MD

Provider Business Mailing Address
First Line	:	1705 CREST DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-3507
Country	:	US
Telephone Number	:	706-324-4065
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 RIVER CHASE DR
Second Line	:	EMERGENCY DEPT.
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-7483
Country	:	US
Telephone Number	:	334-732-3000
Fax Number	:	334-732-3020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	09/11/2025

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