Organization
RICHARD ALAN ELLIS M.D,
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONICA WOODS ELLIS RN (PRACTICE ADMINISTRATOR)
(901) 755-7069
Entity
Organization
Contact information
Practice address
3066 FOUNTAINSIDE DR STE 102, GERMANTOWN, TN 38138-7820
(901) 755-7335
(901) 755-7380
Mailing address
3066 FOUNTAINSIDE DR STE 102, GERMANTOWN, TN 38138-7820
(901) 755-7335
(901) 755-7380
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD016474
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3026121
TENNESSEE MEDICAID
TN
Enumeration date
12/16/2010
Last updated
01/16/2013
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