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General NPI Number Information
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NPI Number | 1457539082
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Entity Type | Individual
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Provider Name | JOHN M TENNIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 1027A EDGEFIELD ST
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City | GREENWOOD
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State | SC
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Zip | 29646-3205
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Country | US
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Telephone | 864-227-9708
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Fax | 864-229-5542
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Provider Business Mailing Address
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Address Line | 1027A EDGEFIELD ST
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City | GREENWOOD
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State | SC
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Zip | 29646-3205
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Country | US
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Telephone | 864-227-9708
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Fax | 864-229-5542
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number | 10951
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License Number State | SC
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