Elleby, Douglas H

Elleby, Douglas H is an individual health care provider with primary practice located at 3825 Medical Park Dr. Ste. 200, Austell GA 30106-6831. He recently has 2 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, Podiatric Medicine & Surgery Service Providers / Podiatrist. Podiatric Medicine & Surgery Service Providers / Podiatrist is his primary health care specialty. Elleby, Douglas H can be contacted via phone (770) 745-5101.

Contact Information

Primary practice address
3825 Medical Park Dr. Ste. 200 Austell GA 30106-6831
Phone: (770) 745-5101
Fax: (770) 745-9740
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 000433 Georgia
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X POD000433 Georgia

Profile Details

NPI number 1871583609
LBN Legal business name Elleby, Douglas H
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 24th, 2005
Last updated Aug 12th, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871583609 NPPES
Georgia MEDICAID 000138993A
Georgia MEDICAID 1756385

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