MR. ELLIS TAVIN (NPI# 1326003179) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326003179 |
| Entity Type | Individual |
| Full Name | MR. ELLIS TAVIN |
| Credential | MD |
| Practice Address |
80 Humphreys Center Dr #100 Memphis TN 38120 |
| Mailing Address |
8110 N Brother Blvd Ste 200 Bartlett TN 38133-2760 |
| Practice Telephone | 9017619030 |
| Practice Fax Number | 9014736505 |
| Mailing Telephone | 9012555221 |
| Mailing Fax Number | 9013734511 |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2020-02-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208200000X | Plastic Surgery | 41308 | TN | Allopathic & Osteopathic Physicians |
| N | 208200000X | Plastic Surgery | 9601744 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 89100200 | 05 |
| Street Address |
80 HUMPHREYS CENTER DR #100 |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38120 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871033472 | Lakina Richmond | Nurse Practitioner | 80 Humphreys Center Dr, Suite 200, Memphis, TN 38120-2353 | 2017-03-01 |
| 1073983540 | Christina Marie Malone | Nurse Practitioner | 80 Humphreys Center Dr, Suite 202, Memphis, TN 38120-2353 | 2015-09-28 |
| 1861876286 | Glenn William Roma | Pharmacist | 80 Humphreys Center Dr, Suite 340, Memphis, TN 38120-2353 | 2015-07-15 |
| 1770983827 | Regina Nuccio | Genetic Counselor, MS | 80 Humphreys Center Dr, Suite #340, Memphis, TN 38120-2353 | 2014-08-26 |
| 1346649175 | Lorrell White | Genetic Counselor, MS | 80 Humphreys Center Dr, #340, Memphis, TN 38120-2353 | 2014-08-18 |
| 1861739385 | Baptist Memorial Hospital | Clinic/Center | 80 Humphreys Center Dr, Suite 200 A, Memphis, TN 38120-2353 | 2013-01-04 |
| 1346482528 | Laboratory Corporation of America Holdings | Clinical Medical Laboratory | 80 Humphreys Center Dr, Ste 330, Memphis, TN 38120-2353 | 2009-04-02 |
| 1104072651 | Nicholas Raymond Leonardi | Plastic Surgery | 80 Humphreys Center Dr, 100, Memphis, TN 38120-2353 | 2008-08-15 |
| 1124241062 | Salil Goorha | Internal Medicine | 80 Humphreys Center Dr, #330, Memphis, TN 38120-2353 | 2007-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093285637 | Cobblestone Midwifery | Midwife | 5617 Ashley Square South, Memphis, TN 38120 | 2018-11-27 |
| 1649768870 | River City Neuropsychology, Pllc | Psychologist | 1661 International Dr., Suite 400, Memphis, TN 38120 | 2018-04-24 |
| 1841676152 | Jody Lavaun Clements | Dentist | 795 Ridge Lake Blvd Ste 101, Memphis, TN 38120 | 2015-08-10 |
| 1578957122 | Christina Lumpkin | Nurse Practitioner | 6305 Humphreys Blvd Ste 101, Memphis, TN 38120 | 2015-03-21 |
| 1316352099 | Daniel Poor | Emergency Medicine | Baptist Memorial Hospital Memphis, 124 N. Humphrey's Blvd, Memphis, TN 38120 | 2014-06-21 |
| 1245643246 | Kysha Saleem | Nurse Practitioner | 6027 Walnut Grove Rd., Suite 312, Memphis, TN 38120 | 2014-06-06 |
| 1376962613 | John Christopher Swearingen | Dentist | 780 Ridge Lake Blvd Ste 101, Memphis, TN 38120 | 2014-04-15 |
| 1275884645 | Rebecca Leigh Goedecke | Nurse Practitioner | 6215 Humphreys Blvd Ste 301, Memphis, TN 38120 | 2012-09-26 |
| 1730475179 | Sarah Elizabeth Hammond | Surgery | Plastic Surgery Group, 80 Humphreys Blvd #100, Memphis, TN 38120 | 2011-06-23 |
| 1922302785 | Daniel L Hester | Nurse Anesthetist, Certified Registered | 1755 Kirby Parkway Suite 330, Memphis, TN 38120 | 2011-01-07 |
| Find all providers in zip 38120 | ||||
| Taxonomy Code | 208200000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Plastic Surgery |
| A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Plastic Surgery, 2007. http://www.abplsurg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Plastic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023244357 | Amie Rae Miller | Plastic Surgery | 920 Madison Ave Ste 447, Memphis, TN 38103-3438 | 2009-06-01 |
| 1154578573 | Sylvia Shepherd Strock | Plastic Surgery | 4634 Peppertree Lane, Memphis, TN 38117 | 2008-08-27 |
| 1538326434 | Melissa Anne Kath | Plastic Surgery | 80 Humphreys Center Dr Ste 100, Memphis, TN 38120-2352 | 2008-05-19 |
| 1043316821 | Dan Huff Shell IIi | Plastic Surgery | 6209 Poplar Ave, Suite 200, Memphis, TN 38119-4712 | 2006-09-16 |
| 1164436226 | Robert Louis Adams | Plastic Surgery | 80 Humphreys Ctr Ste 100, Memphis, TN 38120-2352 | 2006-07-27 |
| 1033598248 | Steven D Kozusko | Plastic Surgery | 910 Madison Ave, Memphis, TN 38103-3403 | 2015-05-20 |
| 1760823595 | Kalyan Chakravarthy Dadireddy | Plastic Surgery | 1068 Cresthaven Rd Ste 500, Memphis, TN 38119-0846 | 2013-07-09 |
| 1851659981 | Haiqiao Jiao | Plastic Surgery | 1068 Cresthaven Rd Ste 500, Memphis, TN 38119-0846 | 2012-04-26 |
| 1720364367 | Petros Konofaos | Plastic Surgery | 1068 Cresthaven Rd, Suite 500, Memphis, TN 38119-0800 | 2011-10-27 |
| 1801185228 | Cedric Lawon Hunter | Plastic Surgery | 1068 Cresthaven Rd Ste 500, Memphis, TN 38119-0846 | 2011-04-06 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.