Provider Demographics
NPI:1588795215
Name:ELLINGTON, JOHN KENT (MD, MS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KENT
Last Name:ELLINGTON
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
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Mailing Address - Street 1:4601 PARK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3239
Mailing Address - Country:US
Mailing Address - Phone:704-323-2000
Mailing Address - Fax:
Practice Address - Street 1:2001 VAIL AVE
Practice Address - Street 2:SUITE 200B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1219
Practice Address - Country:US
Practice Address - Phone:704-323-3616
Practice Address - Fax:704-323-3935
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2010-00602207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5914689Medicaid
NC2075784Medicare PIN
NC0397730024Medicare NSC