MEDICARE: DR. WILLIAM TERRELL JR. M.D.

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	208000000X	Pediatrics Physician	8386	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
2	3054411	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1790789527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM TERRELL JR. M.D.

Provider Business Mailing Address
First Line	:	1444 E SHELBY DR
Second Line	:	STE 317
City	:	MEMPHIS
State	:	TN
Zip	:	38116-7257
Country	:	US
Telephone Number	:	901-396-8281
Fax Number	:	901-396-7535

Provider Business Practice Location Address
First Line	:	1444 E SHELBY DR
Second Line	:	STE 317
City	:	MEMPHIS
State	:	TN
Zip	:	38116-7257
Country	:	US
Telephone Number	:	901-396-8281
Fax Number	:	901-396-7535

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/08/2007

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