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General NPI Number Information
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NPI Number | 1487797114
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Entity Type | Individual
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Provider Name | CHRYSTAL FAYE ELLER MD
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Gender | Female
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 06/24/2013
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Provider Practice Location Address
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Address Line | 522 ALLEN ST SUITE 101
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City | TROY
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State | NC
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Zip | 27371-2861
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Country | US
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Telephone | 910-571-5510
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Fax | 910-571-5539
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Provider Business Mailing Address
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Address Line | 522 ALLEN ST SUITE 101
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City | TROY
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State | NC
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Zip | 27371-2861
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Country | US
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Telephone | 910-571-5510
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Fax | 910-571-5539
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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 | 2007-01048
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License Number State | NC
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