Individual
MR. ELLIS TAVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
80 HUMPHREYS CENTER DR, #100, MEMPHIS, TN 38120
(901) 761-9030
(901) 473-6505
Mailing address
8110 N BROTHER BLVD, STE 200, BARTLETT, TN 38133-2760
(901) 255-5221
(901) 373-4511
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
41308
TN
208200000X
Plastic Surgery Physician
9601744
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89100200
—
NC
Enumeration date
04/17/2006
Last updated
02/06/2020
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