Provider Demographics
NPI:1689813057
Name:BEHAVIORAL MEDICINE CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:BEHAVIORAL MEDICINE CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:BANNISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-255-3030
Mailing Address - Street 1:PO BOX 770875
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38177-0875
Mailing Address - Country:US
Mailing Address - Phone:901-255-3030
Mailing Address - Fax:901-507-7811
Practice Address - Street 1:5384 POPLAR AVE
Practice Address - Street 2:STE 106
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3609
Practice Address - Country:US
Practice Address - Phone:901-255-3030
Practice Address - Fax:901-507-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN251982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3081700Medicare PIN