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General NPI Number Information
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NPI Number | 1205053865
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Entity Type | Individual
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Provider Name | WENDY DREW ELLIS M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 210 25TH AVE N STE 602
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City | NASHVILLE
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State | TN
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Zip | 37203-1631
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Country | US
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Telephone | 615-312-0600
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Fax | 615-320-3259
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Provider Business Mailing Address
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Address Line | 210 25TH AVE N STE 602
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City | NASHVILLE
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State | TN
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Zip | 37203-1631
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Country | US
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Telephone | 615-312-0600
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Fax | 615-320-3259
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | DR.0061234
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 47125
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | DR.0061234
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | MD47125
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License Number State | TN
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