Healthcare Provider Details

I. General information

NPI: 1003984857
Provider Name (Legal Business Name): BEVERLY TURNER ELLINGTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N A ST
EASLEY SC
29640-2144
US

IV. Provider business mailing address

1 INDEPENDENCE PT SUITE 212
GREENVILLE SC
29615-4545
US

V. Phone/Fax

Practice location:
  • Phone: 864-855-0001
  • Fax: 864-855-5030
Mailing address:
  • Phone: 864-797-6015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number158067
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9953
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier102463DL
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerPREFERRED CARE
# 2
Identifier1147117
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 3
IdentifierP010158067
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerBLUE CHOICE
# 4
Identifier158067CP
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerWORKER'S COMP
# 5
IdentifierP010158067
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerBLUE SHIELD
# 6
Identifier099538
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 7
Identifier2697340
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerGHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: