Provider Demographics
NPI:1982469029
Name:ELLY, NOEL
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:ELLY
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 1:1363 HIDDEN RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0111
Mailing Address - Country:US
Mailing Address - Phone:901-857-3240
Mailing Address - Fax:
Practice Address - Street 1:1363 HIDDEN RIDGE LN
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-0111
Practice Address - Country:US
Practice Address - Phone:901-857-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver