Kenneth Ray Ellis MA

NPI 1700103934 - Specialist - 174400000X

NPI Details
NPI 1700103934
Gender Male
Enumeration Date 04/28/2010
Last Updated 04/28/2010
Entity Type Individual
Active Over 6 years ago
Practice Location
2243 EDDIE WILLIAMS RD
JOHNSON CITY TN, 37601-2872, US
Phone (423) 928-5627
Fax (423) 467-3644
Business Location
1167 SPRATLIN PARK DR
GRAY TN, 37615-6205, US
Phone (423) 467-3600
Fax (423) 467-3644
Toxanomy
Taxonomy Code 174400000X
License State
License Number
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According to our database, Kenneth Ray Ellis MA NPI is 1700103934, taxonomy code is 174400000X Kenneth Ray Ellis MA physically located at 2243 Eddie Williams Rd, Johnson City TN, 37601-2872. NPI Number Kenneth Ray Ellis MA has the Individual type.

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1700103934 NPI number is provided on an as is basis without warranty of any kind. 1700103934 is maintained by the National Plan & Provider Enumeration System. The contents of Kenneth Ray Ellis MA are for informational purposes only.