Provider Demographics
NPI:1417911348
Name:NAVE, ELLEN L (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:L
Last Name:NAVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:H
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3889
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-3889
Mailing Address - Country:US
Mailing Address - Phone:423-282-8070
Mailing Address - Fax:423-282-8550
Practice Address - Street 1:303 MED TECH PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-282-8070
Practice Address - Fax:423-282-8550
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD37471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1515227Medicaid
TN3886457Medicaid
TN4106757OtherBLUE CROSS BLUE SHIELD
TN1515227Medicaid
TN3886457Medicaid