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General NPI Number Information
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NPI Number | 1760483770
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Entity Type | Organization
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Legal Business Name | ELLINGTON MEMORIAL CLINIC, LLP
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1011 SOUTH WILLIAMS STREET
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City | ATLANTA
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State | TX
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Zip | 75551-3245
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Country | US
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Telephone | 903-796-2868
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Fax | 903-796-0826
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Provider Business Mailing Address
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Address Line | 1011 SOUTH WILLIAMS STREET
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City | ATLANTA
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State | TX
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Zip | 75551-3245
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Country | US
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Telephone | 903-796-2868
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Fax | 903-796-0826
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Authorized Official
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Title or Position | OFFICE MGR
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Name | MRS. ANITA G CARNEY
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Credential |
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Telephone | 903-796-2868
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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 |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State | TX
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