Provider Demographics
NPI:1235404013
Name:SOUTH, TERRY L (NP-C)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:SOUTH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 EAST LAMAR ALEXANDER PARKWAY
Mailing Address - Street 2:BLDG 2, STE 103
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804
Mailing Address - Country:US
Mailing Address - Phone:865-285-9284
Mailing Address - Fax:888-491-4597
Practice Address - Street 1:1103 EAST LAMAR ALEXANDER PARKWAY
Practice Address - Street 2:BLDG 2, STE 103
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804
Practice Address - Country:US
Practice Address - Phone:865-285-9284
Practice Address - Fax:888-491-4597
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16534363LF0000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily