Ellett, Justin Daniel
Ellett, Justin Daniel is an sole proprietor health care provider with primary practice located at 2687 Lake Park Drive , N Charleston SC 29406. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Ellett, Justin Daniel can be contacted via phone (843) 572-1010.Contact Information
Primary practice address
2687 Lake Park Drive
N Charleston SC 29406
Phone: (843) 572-1010
Fax: (843) 569-1719
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Urology | 208800000X | 33598 | South Carolina |
Profile Details
| NPI number | 1275827248 |
|---|---|
| LBN Legal business name | Ellett, Justin Daniel |
| Credentials | MD, PHD |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 7th, 2011 |
| Last updated | Feb 17th, 2017 - about 8 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1275827248 | NPPES |
| South Carolina | MEDICAID | 335989 | |
| South Carolina | Other | 1275827248 |
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