Individual
ERIC R ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
605 GLENWOOD DRIVE, SUITE 200, CHATTANOOGA, TN 37404-1130
(423) 698-1844
(423) 624-2226
Mailing address
PO BOX 440261, NASHVILLE, TN 37244-0261
(423) 698-1844
(423) 624-2226
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD0000019592
TN
2085R0001X
Radiation Oncology Physician
Primary
MD0000019592
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3047073
—
TN
Enumeration date
02/21/2006
Last updated
01/28/2013
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