Provider Demographics
NPI:1003984857
Name:ELLINGTON, BEVERLY TURNER (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:TURNER
Last Name:ELLINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6015
Mailing Address - Fax:
Practice Address - Street 1:800 N A ST
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-2144
Practice Address - Country:US
Practice Address - Phone:864-855-0001
Practice Address - Fax:864-855-5030
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158067208000000X
SC9953208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY102463DLOtherPREFERRED CARE
NY1147117Medicaid
NYP010158067OtherBLUE CHOICE
NY158067CPOtherWORKER'S COMP
NYP010158067OtherBLUE SHIELD
SC099538Medicaid
NY2697340OtherGHI
SCAA86057951Medicare PIN
NY2697340OtherGHI