Healthcare Provider Details

I. General information

NPI: 1083703003
Provider Name (Legal Business Name): THOMAS TERRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: THOMAS ROLAND TERRELL M.D.

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 EXECUTIVE PARK DR
CLINTON TN
37716
US

IV. Provider business mailing address

110 EXECUTIVE PARK DR
CLINTON TN
37716-6876
US

V. Phone/Fax

Practice location:
  • Phone: 865-494-9241
  • Fax: 865-494-0895
Mailing address:
  • Phone: 865-494-9241
  • Fax: 865-494-0895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number038858
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number038858
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: