Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 5385 | TN |
Y | 1223P0300X | Periodontist | 5033 | AL |
NPI | 1043308026 |
---|---|
Provider Name | Dr. Terri Cooper Colquitt |
First Address | Nashville, TN 37204 |
Second Address | Nashville, TN 37208-3501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 31/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009932145 | (05) | AL |
96964 | (02) |