Healthcare Provider Details

I. General information

NPI: 1073748026
Provider Name (Legal Business Name): SARAH EISEN ELLIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH HARWI EISEN MD

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 DUNLOP LN SUITE 305
CLARKSVILLE TN
37040-5165
US

IV. Provider business mailing address

509 BILTMORE AVE
ASHEVILLE NC
28801-4601
US

V. Phone/Fax

Practice location:
  • Phone: 931-802-5515
  • Fax: 931-802-5518
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2022-00823
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number52885
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number52885
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberTP571
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: