Healthcare Provider Details

I. General information

NPI: 1649214586
Provider Name (Legal Business Name): TIMOTHY ELLINGTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4803 WESLEY ST
GREENVILLE TX
75401-5649
US

IV. Provider business mailing address

PO BOX 957
GREENVILLE TX
75403-0957
US

V. Phone/Fax

Practice location:
  • Phone: 903-408-7750
  • Fax: 903-408-7802
Mailing address:
  • Phone: 903-408-7750
  • Fax: 903-408-7802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberF6603
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: