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General NPI Number Information
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NPI Number | 1497805014
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Entity Type | Individual
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Provider Name | ANTHONY REED ELLIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 1040 W BRISTOL RD
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City | FLINT
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State | MI
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Zip | 48507-5516
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Country | US
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Telephone | 810-257-3724
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Fax |
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Provider Business Mailing Address
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Address Line | 440 PUPPET PL
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City | HENDERSONVILLE
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State | NC
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Zip | 28792-5578
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Country | US
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Telephone | 810-394-3126
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301063866
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License Number State | MI
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