MEDICARE: DR. WENDY DREW ELLIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085P0229X	Pediatric Radiology Physician	MD47125	TN
2	2085R0202X	Diagnostic Radiology Physician	DR.0061234	CO
3	2085P0229X	Pediatric Radiology Physician	DR.0061234	CO
4	2085P0229X	Pediatric Radiology Physician	036-148689	IL
5	2085R0202X	Diagnostic Radiology Physician	47125	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205053865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WENDY DREW ELLIS MD

Provider Business Mailing Address
First Line	:	210 25TH AVE N STE 602
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1631
Country	:	US
Telephone Number	:	615-312-0600
Fax Number	:	615-320-3259

Provider Business Practice Location Address
First Line	:	210 25TH AVE N STE 602
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1631
Country	:	US
Telephone Number	:	615-312-0600
Fax Number	:	615-320-3259

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	01/27/2026

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