Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 0807 | NC |
Y | 213ES0000X | Sports Medicine | 0807 | NC |
NPI | 1194478925 |
---|---|
Provider Name | Adam Tracy Elliott |
First Address | West Jefferson, NC 28694-0450 |
Second Address | West Jefferson, NC 28694-0450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2022 |
Last Update Date | 01/02/2022 |