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NPI Code Detail

MEDICARE: DR. WILLIAM BLOUNT ELLISON JR. M.D.

MEDICARE: DR. WILLIAM BLOUNT ELLISON JR. 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
1207RI0011XInterventional Cardiology Physician8245SC

General Provider Information

NPI Number : 1356307318
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM BLOUNT ELLISON JR. M.D.
Provider Business Mailing Address
First Line : 1033 SAINT ANDREWS BLVD
Second Line :
City : CHARLESTON
State : SC
Zip : 29407-7156
Country : US
Telephone Number : 843-723-6111
Fax Number : 843-723-0675
Provider Business Practice Location Address
First Line : 1033 SAINT ANDREWS BLVD
Second Line :
City : CHARLESTON
State : SC
Zip : 29407-7156
Country : US
Telephone Number : 843-723-6111
Fax Number : 843-723-0675
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2006
Last Update Date : 01/25/2021

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