Healthcare Provider Details

I. General information

NPI: 1265494488
Provider Name (Legal Business Name): TERESA M PATTERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 WILSON AVE
TULLAHOMA TN
37388-3353
US

IV. Provider business mailing address

209 WILSON AVE
TULLAHOMA TN
37388-3353
US

V. Phone/Fax

Practice location:
  • Phone: 931-455-2525
  • Fax: 931-455-2505
Mailing address:
  • Phone: 931-455-2525
  • Fax: 931-455-2505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9548
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD9548
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD9548
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD9548
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD9548
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: