Individual
CARRIE DIANE ELLIS-COLANDRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
7541 CROSSWOOD BLVD, SUITE 1, KNOXVILLE, TN 37924-3935
(865) 524-1661
(865) 523-8406
Mailing address
1225 E WEISGARBER RD, SUITE 200, KNOXVILLE, TN 37909-2604
(865) 584-4747
(865) 584-1363
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1931
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3721613
MEDICARE GROUP #
TN
Enumeration date
08/06/2007
Last updated
07/11/2017
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