Provider Demographics
NPI:1750452520
Name:HOLDER, TERRY SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:SCOTT
Last Name:HOLDER
Suffix:
Gender:M
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:PO BOX 712
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2494
Mailing Address - Country:US
Mailing Address - Phone:931-962-2229
Mailing Address - Fax:931-967-8918
Practice Address - Street 1:155 HOSPITAL RD
Practice Address - Street 2:STE #A
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2494
Practice Address - Country:US
Practice Address - Phone:931-962-2229
Practice Address - Fax:931-967-8918
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD19010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
113108OtherBCBSTN
TN3036689Medicaid
C36417Medicare UPIN
TN3036689Medicaid