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General NPI Number Information
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NPI Number | 1588032387
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Entity Type | Organization
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Legal Business Name | FOCUS-MD TN1017, PLLC
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Dates
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Enumeration Date | 09/10/2015
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 105 BLUEGRASS COMMONS BLVD STE B
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-2772
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Country | US
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Telephone | 615-686-2346
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Fax | 615-535-0230
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Provider Business Mailing Address
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Address Line | 105 BLUEGRASS COMMONS BLVD STE B
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-2772
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Country | US
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Telephone | 615-686-2346
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Fax | 615-535-0230
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MADELINE ELLIS
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Credential | MD
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Telephone | 615-686-2346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | TN
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