Provider Demographics
NPI:1265494488
Name:PATTERSON, TERESA M (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3353
Mailing Address - Country:US
Mailing Address - Phone:931-455-2525
Mailing Address - Fax:931-455-2505
Practice Address - Street 1:209 WILSON AVE
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3353
Practice Address - Country:US
Practice Address - Phone:931-455-2525
Practice Address - Fax:931-455-2505
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD9548207R00000X, 208000000X, 207RN0300X, 207Q00000X
TN9548207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3163904Medicaid
TN621035267OtherTAX ID
TN3163904Medicare PIN
TNB59307Medicare UPIN