Provider Demographics
NPI:1356307318
Name:ELLISON, WILLIAM BLOUNT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BLOUNT
Last Name:ELLISON
Suffix:JR
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1033 SAINT ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7156
Mailing Address - Country:US
Mailing Address - Phone:843-723-6111
Mailing Address - Fax:843-723-0675
Practice Address - Street 1:1033 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7156
Practice Address - Country:US
Practice Address - Phone:843-723-6111
Practice Address - Fax:843-723-0675
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC8245207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB92250Medicare UPIN