Mark Frederick Ellison, M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

026107 Issued in GA

Practice address

2142 W Broad St
Building 200, Suite 200
Athens, GA 30606-3506

Phone

(706) 612-9401

Fax

(706) 612-9410

NPI assigned

Jul 14, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Interoperability endpoints

• Direct secure messaging: mark.ellison@ewb-urology.gadirect.net

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1265431092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6127",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306046127",
            "telephone_number": "706-612-9401",
            "fax_number": "706-612-9410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2142 W BROAD ST",
            "address_2": "BUILDING 200, SUITE 200",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306063506",
            "telephone_number": "706-612-9401",
            "fax_number": "706-612-9410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "MARK",
        "middle_name": "FREDERICK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-14",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "GA",
            "license": "026107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000370994F",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ron Elliott, MD
• Tyler-Curtis Cory Elliott, MED, BCBA
• Catherine Paige Ellis, LMSW
• Mark A Ellis, MD
• April Lynne Ellison, RN
• Grady Elmore, N.P.
• James A Elmore, M.D.
• Cristina Elstad, M.D.
• David Elvington, PAAA
• Nick Emamifar

• Urology Physician in Athens, GA
• Providers in Athens, GA by specialty
• Urology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.