Provider Demographics
NPI:1619452331
Name:ELLINGTON, PATRICK LEE
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:LEE
Last Name:ELLINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 OLD HICKORY BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5387
Mailing Address - Country:US
Mailing Address - Phone:615-371-6106
Mailing Address - Fax:
Practice Address - Street 1:750 OLD HICKORY BLVD STE 150
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5387
Practice Address - Country:US
Practice Address - Phone:615-371-6106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5782246ZE0500X
TN2045246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG