Organization
SOUTHERN TENNESSEE RADIOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL D ELLIS MD (OWNER)
(866) 457-9896
Entity
Organization
Contact information
Practice address
185 HOSPITAL RD, WINCHESTER, TN 37398
(866) 457-9896
(706) 226-2283
Mailing address
PO BOX 2125, DALTON, GA 30720
(866) 457-9896
(706) 226-2283
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3732584
—
TN
01
—
DE2147
RAILROAD MEDICARE
TN
Enumeration date
06/25/2006
Last updated
10/23/2007
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