MEDICARE: MCCURDY & ELLIS. PLC

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	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center

General Provider Information

NPI Number	:	1245315621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCCURDY & ELLIS. PLC

Provider Business Mailing Address
First Line	:	1718 MEMORIAL DR
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37043-4542
Country	:	US
Telephone Number	:	931-552-4935
Fax Number	:

Provider Business Practice Location Address
First Line	:	1718 MEMORIAL DR
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37043-4542
Country	:	US
Telephone Number	:	931-552-4935
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PARTNER
Name	:	R. TERRY ELLIS
Credential	:
Telephone Number	:	931-552-4935

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	08/22/2020

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