MEDICARE: THOMAS S. 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	207XS0117X	Orthopaedic Surgery of the Spine Physician	97-00936	NC
2	207XS0117X	Orthopaedic Surgery of the Spine Physician	24839	SC
3	207XS0117X	Orthopaedic Surgery of the Spine Physician	TL24839	SC

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	:	1780630574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS S. ELLISON MD

Provider Business Mailing Address
First Line	:	PO BOX 421718
Second Line	:
City	:	GEORGETOWN
State	:	SC
Zip	:	29442-4203
Country	:	US
Telephone Number	:	843-527-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4040 HIGHWAY 17 UNIT 301
Second Line	:
City	:	MURRELLS INLET
State	:	SC
Zip	:	29576-5098
Country	:	US
Telephone Number	:	843-652-8205
Fax Number	:	843-652-8215

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	09/30/2025

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Directions to “ THOMAS S. ELLISON MD” Practice Location

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