MEDICARE: DR. GARRETTSON S ELLIS M.D.

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	207RP1001X	Pulmonary Disease Physician	38522	TN
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	38522	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38943941	OTHER	TN	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336145317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARRETTSON S ELLIS M.D.

Provider Business Mailing Address
First Line	:	5050 POPLAR AVE
Second Line	:	SUITE 800
City	:	MEMPHIS
State	:	TN
Zip	:	38157-0101
Country	:	US
Telephone Number	:	901-276-2662
Fax Number	:	901-274-1871

Provider Business Practice Location Address
First Line	:	5050 POPLAR AVE
Second Line	:	SUITE 800
City	:	MEMPHIS
State	:	TN
Zip	:	38157-0101
Country	:	US
Telephone Number	:	901-276-2662
Fax Number	:	901-274-1871

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	06/21/2013

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Directions to “ DR. GARRETTSON S ELLIS M.D.” Practice Location

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