Individual
JAMES SHANNON ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
105 CHAMBLISS DR, HARDINSBURG, KY 40143-2575
(270) 756-2424
Mailing address
105 CHAMBLISS DR, HARDINSBURG, KY 40143-2575
(270) 756-2424
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
38786
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38786
LICENSE
KY
Enumeration date
06/02/2005
Last updated
12/09/2008
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