Provider Demographics
NPI:1972608958
Name:ELLWOOD, HILARY KATE (MD)
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:KATE
Last Name:ELLWOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3188 S LIZELLA RD
Mailing Address - Street 2:
Mailing Address - City:LIZELLA
Mailing Address - State:GA
Mailing Address - Zip Code:31052-4123
Mailing Address - Country:US
Mailing Address - Phone:478-988-1865
Mailing Address - Fax:478-988-1869
Practice Address - Street 1:3188 S LIZELLA RD
Practice Address - Street 2:
Practice Address - City:LIZELLA
Practice Address - State:GA
Practice Address - Zip Code:31052-4123
Practice Address - Country:US
Practice Address - Phone:478-988-1865
Practice Address - Fax:478-988-1869
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00495019BMedicaid
GA00495019BMedicaid
GA08BBVDPMedicare ID - Type Unspecified