Healthcare Provider Details

I. General information

NPI: 1023081726
Provider Name (Legal Business Name): ELISSA BETH RYMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8545 HERRING HILL RD
MILLINGTON TN
38053-5128
US

IV. Provider business mailing address

8545 HERRING HILL RD
MILLINGTON TN
38053-5128
US

V. Phone/Fax

Practice location:
  • Phone: 901-876-3619
  • Fax:
Mailing address:
  • Phone: 901-876-3619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1739
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: