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Individual

JOHN A ELLZEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
6019 WALNUT GROVE, MEMPHIS, TN 38120
(901) 383-8860
(901) 383-1194
Mailing address
7600 WOLF RIVER BLVD STE 200, GERMANTOWN, TN 38138-1788
(901) 747-1000
(901) 747-1001

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
36589
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00122829
MS
05
142994001
AR
05
209040203
MO
05
3883156
TN
01
4065404
BCBS
TN
01
5L864
BCBS
AR
01
P00032804
RR MEDICARE
TN
01
P00294088
RR MEDICARE
MS
Enumeration date
08/19/2006
Last updated
01/28/2022
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