MEDICARE: THOMAS G BANNISTER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	25198	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881701985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS G BANNISTER MD

Provider Business Mailing Address
First Line	:	5384 POPLAR AVE
Second Line	:	SUITE 106
City	:	MEMPHIS
State	:	TN
Zip	:	38119-3609
Country	:	US
Telephone Number	:	901-255-3030
Fax Number	:	901-507-7811

Provider Business Practice Location Address
First Line	:	5384 POPLAR AVE
Second Line	:	SUITE 106
City	:	MEMPHIS
State	:	TN
Zip	:	38119-3609
Country	:	US
Telephone Number	:	901-255-3030
Fax Number	:	901-507-7811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	01/16/2009

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Directions to “ THOMAS G BANNISTER MD” Practice Location

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