Provider Demographics
NPI:1093972929
Name:HADDAD, ELLEN K (DO)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:K
Last Name:HADDAD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ELLEN
Other - Middle Name:G
Other - Last Name:KRIMITSOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:300 RAWLS DR
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2877
Mailing Address - Country:US
Mailing Address - Phone:601-250-4210
Mailing Address - Fax:601-250-4212
Practice Address - Street 1:300 RAWLS DR
Practice Address - Street 2:SUITE 1000
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2877
Practice Address - Country:US
Practice Address - Phone:601-250-4210
Practice Address - Fax:601-250-4212
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-2438390200000X
MS220392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program