Provider Demographics
NPI:1861401606
Name:ELLIS, PATRICK CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:CHRISTOPHER
Last Name:ELLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:910-662-9500
Mailing Address - Fax:910-668-9501
Practice Address - Street 1:584 HOSPITAL DR NE
Practice Address - Street 2:
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422-0019
Practice Address - Country:US
Practice Address - Phone:910-662-9500
Practice Address - Fax:910-668-9501
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01336207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908850Medicaid
NC1861401606Medicaid
NC2071420BMedicare PIN
NC5908850Medicaid
NCNCA337AMedicare PIN
H78604Medicare UPIN
NC1861401606Medicaid