Provider Demographics
NPI:1851501308
Name:FLEMING, ELLIOTT TEMPLE (PT)
Entity Type:Individual
Prefix:MR
First Name:ELLIOTT
Middle Name:TEMPLE
Last Name:FLEMING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 63RD ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-1147
Mailing Address - Country:US
Mailing Address - Phone:601-693-8507
Mailing Address - Fax:
Practice Address - Street 1:RILEY MEMORIAL HOSPITAL
Practice Address - Street 2:1102 CONSTITUTION AVE
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-7170
Practice Address - Country:US
Practice Address - Phone:601-484-3298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT 0036273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit