Individual
DR. THOMAS W ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2863 HIGHWY 45 BYP, JACKSON, TN 38305-3618
(731) 422-0213
(731) 422-0410
Mailing address
PO BOX 400, JACKSON, TN 38302-0400
(731) 425-5752
(731) 425-5783
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
MD8209
TN
207RS0012X
Sleep Medicine (Internal Medicine) Physician
MD8209
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31909201
—
TN
Enumeration date
06/03/2006
Last updated
10/25/2023
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