DR. MARK FREDERICK ELLISON M.D. NPI 1265431092

NPI Information

NPI: 1265431092
Provider Name: DR. MARK FREDERICK ELLISON, M.D.
Classification: Urology - 208800000X
Entity Type: Individual
Address:
2142 W BROAD ST
BUILDING 200, SUITE 200
ATHENS, GA
ZIP 30606
Phone: (706) 612-9401
Get Directions

DR. Mark Frederick Ellison, M.D. is an urology in Athens, GA. The provider is a urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. DR. Mark Frederick Ellison, M.D. NPI is 1265431092. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2142 W BROAD ST
BUILDING 200, SUITE 200
ATHENS, GA
ZIP 30606-506
Phone: (706) 612-9401
Fax: (706) 612-9410

The enumeration date for this NPI number is 7/14/2005 and was last updated on 3/7/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208800000X	Urology		026107	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000370994F	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »