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1164776837

NPI Code Detail

MEDICARE: DEE ANN ELLIS MD

MEDICARE: DEE ANN ELLIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	9300692	NC
2	207R00000X	Internal Medicine Physician	14901	SC

General Provider Information

NPI Number	:	1164776837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEE ANN ELLIS MD

Provider Business Mailing Address
First Line	:	6115 PARK SOUTH DRIVE
Second Line	:	SUITE 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3281
Country	:	US
Telephone Number	:	704-554-8787
Fax Number	:	704-554-8774

Provider Business Practice Location Address
First Line	:	6115 PARK SOUTH DRIVE
Second Line	:	SUITE 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3281
Country	:	US
Telephone Number	:	704-554-8787
Fax Number	:	704-554-8774

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2012
Last Update Date	:	11/02/2012

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Directions to “ DEE ANN ELLIS MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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