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NPI Code Detail

MEDICARE: ELIZABETH CAROLYN ELLIOTT

MEDICARE: ELIZABETH CAROLYN ELLIOTT
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
1208000000XPediatrics Physician48574TN
2390200000XStudent in an Organized Health Care Education/Training Program
3207R00000XInternal Medicine Physician48574TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649444365
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH CAROLYN ELLIOTT
Provider Business Mailing Address
First Line : 4528 DEE RD
Second Line :
City : MEMPHIS
State : TN
Zip : 38117-5408
Country : US
Telephone Number : 205-999-9485
Fax Number :
Provider Business Practice Location Address
First Line : 5339 ELVIS PRESLEY BLVD
Second Line :
City : MEMPHIS
State : TN
Zip : 38116-8243
Country : US
Telephone Number : 901-271-9500
Fax Number : 901-271-9501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2008
Last Update Date : 03/22/2024

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Directions to “ ELIZABETH CAROLYN ELLIOTT ” Practice Location

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