Provider Demographics
NPI:1588032387
Name:FOCUS-MD TN1017, PLLC
Entity Type:Organization
Organization Name:FOCUS-MD TN1017, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-686-2346
Mailing Address - Street 1:105 BLUEGRASS COMMONS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2772
Mailing Address - Country:US
Mailing Address - Phone:615-686-2346
Mailing Address - Fax:615-535-0230
Practice Address - Street 1:105 BLUEGRASS COMMONS BLVD STE B
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2772
Practice Address - Country:US
Practice Address - Phone:615-686-2346
Practice Address - Fax:615-535-0230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty