Provider Demographics
NPI:1548479041
Name:ELLINGTON, THOMAS CECIL (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CECIL
Last Name:ELLINGTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9639 HIGHWAY 5
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1513
Mailing Address - Country:US
Mailing Address - Phone:770-942-0622
Mailing Address - Fax:
Practice Address - Street 1:9639 HIGHWAY 5
Practice Address - Street 2:SUITE 101
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1513
Practice Address - Country:US
Practice Address - Phone:770-942-0622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0081741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice