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Individual

DR. JAMES LEE ELLIS JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
620 SKYLINE DRIVE, JACKSON, TN 38301
(731) 541-6174
(731) 541-8008
Mailing address
PO BOX 11955, JACKSON, TN 38308-0132
(731) 541-5000
(614) 210-1886

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
16362
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
300056938
RR MEDICARE
05
3018989
TN
01
3058561
BCBS
05
3328435
TN
05
3328436
TN
01
4102603
BCBS
Enumeration date
03/06/2006
Last updated
07/15/2025
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