| Doctor Name: | CAROLYN ELLIS |
| NPI Number: | 1104291533 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 1087 |
| Business Practice Address: | 1904 Highway 46 S Suite 3 Dickson, TN - 370557744 |
| Business Phone Number: | 6153758469 |
| Business Fax Number: | |
| Mailing Address: | 2203 Sandra Dr, NASHVILLE |
| State: | TN |
| Postal Code: | 372105031 |
| Phone Number: | 8654062396 |
| Fax Number: | |
| NPI Enumeration Date: | 12/10/2015 |
| NPI Last Update Date: | 12/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 1087 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |