Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | LL30874 | SC |
N | 111NI0900X | Internist | LL30874 | SC |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 69187 | GA |
N | 2081P2900X | Pain Medicine | 69187 | GA |
NPI | 1306005202 |
---|---|
Provider Name | Tambrea Toylett Ellison |
First Address | Atlanta, GA 30318-8232 |
Second Address | Stockbridge, GA 30281-7343 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2008 |
Last Update Date | 07/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003137503A | (05) | GA |
003137503B | (05) | GA |
003137503C | (05) | GA |
003137503D | (05) | GA |
003137503E | (05) | GA |
003137503F | (05) | GA |