MEDICARE: ERIKA LYNETTE ELLISON 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	208000000X	Pediatrics Physician	2025-01801	NC

General Provider Information

NPI Number	:	1245869692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA LYNETTE ELLISON MD

Provider Business Mailing Address
First Line	:	4501 CAMERON VALLEY PKWY STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-4298
Country	:	US
Telephone Number	:	704-367-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 CAMERON VALLEY PKWY STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-4298
Country	:	US
Telephone Number	:	704-367-7400
Fax Number	:

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

Provider Enumeration Date	:	04/07/2020
Last Update Date	:	12/09/2025

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