Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 39576 | TN |
Y | 208600000X | Surgeon | 39576 | TN |
NPI | 1003918731 |
---|---|
Provider Name | Dr. Adam Wesley Ellis |
First Address | Russellville, KY 42276-8889 |
Second Address | Russellville, KY 42276-8889 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 03/02/2009 |