Provider Demographics
NPI:1518412105
Name:ELLIOTT III, EDWARD III (APN)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:ELLIOTT III
Suffix:III
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:2340 FAIRVIEW BLVD STE 600D
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TN
Practice Address - Zip Code:37062-9457
Practice Address - Country:US
Practice Address - Phone:615-266-2177
Practice Address - Fax:615-266-2331
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6077736OtherBCBS TN
TNQ023865Medicaid
TN1035057I46Medicare PIN