Healthcare Provider Details

I. General information

NPI: 1548354475
Provider Name (Legal Business Name): DONALD T. ELLENBURG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 HIGHLAND AVE
KNOXVILLE TN
37916-1111
US

IV. Provider business mailing address

2121 HIGHLAND AVE
KNOXVILLE TN
37916-1111
US

V. Phone/Fax

Practice location:
  • Phone: 865-525-2640
  • Fax: 865-525-9536
Mailing address:
  • Phone: 865-525-2640
  • Fax: 865-525-9536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31722
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number3958
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: