Provider Demographics
NPI:1932234804
Name:ELLIOTT, JAMES KEITH (DPH)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KEITH
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 BEECHNUT ST
Mailing Address - Street 2:E 9
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1542
Mailing Address - Country:US
Mailing Address - Phone:423-282-5196
Mailing Address - Fax:
Practice Address - Street 1:5908 HIGHWAY 11 E
Practice Address - Street 2:
Practice Address - City:PINEY FLATS
Practice Address - State:TN
Practice Address - Zip Code:37686-4743
Practice Address - Country:US
Practice Address - Phone:423-538-4397
Practice Address - Fax:423-926-9921
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5296183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist