MEDICARE: DR. AARON GREGORY 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	207Q00000X	Family Medicine Physician	2004-00205	NC
2	207QS0010X	Sports Medicine (Family Medicine) Physician	2004-00205	NC

Other Identifiers

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

General Provider Information

NPI Number	:	1730154659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AARON GREGORY ELLISON MD

Provider Business Mailing Address
First Line	:	PO BOX 601067
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-1067
Country	:	US
Telephone Number	:	704-801-3050
Fax Number	:	704-801-3026

Provider Business Practice Location Address
First Line	:	9908 COULOAK DR
Second Line	:	SUITE 202
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-8678
Country	:	US
Telephone Number	:	704-801-3050
Fax Number	:	704-801-3026

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	11/22/2016

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