Individual
MRS. TAMMY ALLEEN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-A
Contact information
Practice address
3400 HIGHWAY 78 E, 205 MEDICAL ARTS TOWER, JASPER, AL 35501-8907
(205) 221-4630
(205) 221-4731
Mailing address
833 SAINT VINCENTS DR, POB#3 SUITE 402, BIRMINGHAM, AL 35205-1606
(205) 933-9236
(205) 933-9213
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
0768A
AL
237600000X
Audiologist-Hearing Aid Fitter
Primary
0768A
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113797
—
AL
01
—
51598737
BLUE CROSS BLUE SHIELD OF ALABAMA
AL
Enumeration date
09/23/2008
Last updated
08/12/2013
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