Individual
ROBERT ELLIS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6025 WALNUT GROVE RD STE 301, MEMPHIS, TN 38120-2123
(901) 226-0456
(901) 226-0458
Mailing address
965 RIDGE LAKE BLVD STE 315, MEMPHIS, TN 38120-9401
(877) 348-1281
(901) 227-3206
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
5490
TN
363AS0400X
Surgical Physician Assistant
PA00540
MS
Other
Enumeration date
02/23/2021
Last updated
02/24/2025
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