Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 038858 | TN |
N | 207QS0010X | Family Doctor - Sports Medicine | 038858 | TN |
NPI | 1083703003 |
---|---|
Provider Name | Dr. Thomas Terrell |
First Address | Clinton, TN 37716-6876 |
Second Address | Clinton, TN 37716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 01/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000352900 | (05) | FL |
103I083671 | MEDICARE PTAN UFP (01) | TN |
1522707 | (05) | TN |
1522707 | MEDICAID PTAN UFP (01) | TN |
3373352 | MEDICARE GRP UFP (01) | TN |
4278768 | BCBS TN UFP (01) | TN |
F50121 | (02) | FL |
P00923551 | RR MEDICARE UFP (01) | TN |