Healthcare Provider Details

I. General information

NPI: 1487797114
Provider Name (Legal Business Name): CHRYSTAL FAYE ELLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 ALLEN ST SUITE 101
TROY NC
27371-2861
US

IV. Provider business mailing address

522 ALLEN ST SUITE 101
TROY NC
27371-2861
US

V. Phone/Fax

Practice location:
  • Phone: 910-571-5510
  • Fax: 910-571-5539
Mailing address:
  • Phone: 910-571-5510
  • Fax: 910-571-5539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2007-01048
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: