Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 2008023487 | MO |
N | 208600000X | Surgeon | 2008023487 | MO |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 52084 | KY |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 54552 | TN |
N | 208G00000X | Cardiothoracic Vascular Surgeon | TP975 | KY |
NPI | 1154579605 |
---|---|
Provider Name | Christopher Ellington |
First Address | Augusta, GA 30901-5110 |
Second Address | Augusta, GA 30901-5110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2008 |
Last Update Date | 08/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300021105 | (05) | IN |
7100571670 | (05) | KY |
Q024290 | (05) | TN |