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DR. RUSSELL JOHN ELLICOTT D.P.M. NPI 1720022452


NPI Information

NPI: 1720022452
Provider Name: DR. RUSSELL JOHN ELLICOTT, D.P.M.
Classification: Podiatrist - 213E00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
501 FURYS FERRY RD
MARTINEZ, GA
ZIP 30907
Phone: (706) 738-3298
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DR. Russell John Ellicott, D.P.M. is a podiatrist in Martinez, GA with 42 years of experience. The provider is a podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. DR. Russell John Ellicott, D.P.M. NPI is 1720022452. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: KENT STATE UNIVERSITY COLLEGE OF PODIATRIC MEDICINE
Graduation Year:1982

The provider's business location address is:

501 FURYS FERRY RD
MARTINEZ, GA
ZIP 30907-059
Phone: (706) 738-3298
Fax: (706) 364-4290

The NPI 1720022452 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 6/15/2006 and was last updated on 2/6/2019.


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
1213E00000XPodiatristPOD000558GEORGIAYes
2213E00000XPodiatrist96SOUTH CAROLINANo

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
100336124AMEDICAIDGEORGIA

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: 5/5/2024

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.