Provider Demographics
NPI:1124128632
Name:MCOMIE, ELLEN S (MDM)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:S
Last Name:MCOMIE
Suffix:
Gender:F
Credentials:MDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 SOLITUDE DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37416-1470
Mailing Address - Country:US
Mailing Address - Phone:423-326-1803
Mailing Address - Fax:423-899-1125
Practice Address - Street 1:5999 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1683
Practice Address - Country:US
Practice Address - Phone:423-899-1112
Practice Address - Fax:423-899-1125
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7522122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist