Healthcare Provider Details

I. General information

NPI: 1275807919
Provider Name (Legal Business Name): JONATHAN ELLEMENT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2012
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 CANNON ST STE 402
CHARLESTON SC
29425-8909
US

IV. Provider business mailing address

9040 FITZSIMMONS DR
JOINT BASE LEWIS MCCHORD WA
98431-1000
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-9707
  • Fax:
Mailing address:
  • Phone: 253-968-2997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberSCMD52755
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: