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General NPI Number Information
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NPI Number | 1326030354
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Entity Type | Individual
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Provider Name | THOMAS JOSEPH ELLIS MD
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Gender | Male
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 1204 E FIRE TOWER RD ECU PHYSICIANS FAMILY MEDICINE FIRETOWER MEDICAL OFFICE
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City | GREENVILLE
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State | NC
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Zip | 27858-4196
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Country | US
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Telephone | 252-744-1122
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Fax | 252-744-1133
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Provider Business Mailing Address
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Address Line | 5213 S ALSTON AVE
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City | DURHAM
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State | NC
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Zip | 27713-4430
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Country | US
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Telephone | 919-620-4855
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9400483
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License Number State | NC
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