Provider Demographics
NPI:1194478925
Name:ELLIOTT, ADAM TRACY (ATC)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:TRACY
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:ATC
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 450
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-0450
Mailing Address - Country:US
Mailing Address - Phone:336-846-2400
Mailing Address - Fax:
Practice Address - Street 1:184 CAMPUS DRIVE
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-0450
Practice Address - Country:US
Practice Address - Phone:336-846-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08072081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine