Healthcare Provider Details

I. General information

NPI: 1487957304
Provider Name (Legal Business Name): ELLEN M EMMONS AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2010
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 E N B BAROODY ST
FLORENCE SC
29506-2523
US

IV. Provider business mailing address

153 E N B BAROODY ST
FLORENCE SC
29506-2523
US

V. Phone/Fax

Practice location:
  • Phone: 843-662-7802
  • Fax: 843-662-5609
Mailing address:
  • Phone: 843-662-7802
  • Fax: 843-662-5609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3692
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: