Provider Demographics
NPI:1790789527
Name:TERRELL, WILLIAM JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:TERRELL
Suffix:JR
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 1:1444 E SHELBY DR
Mailing Address - Street 2:STE 317
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-7257
Mailing Address - Country:US
Mailing Address - Phone:901-396-8281
Mailing Address - Fax:901-396-7535
Practice Address - Street 1:1444 E SHELBY DR
Practice Address - Street 2:STE 317
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-7257
Practice Address - Country:US
Practice Address - Phone:901-396-8281
Practice Address - Fax:901-396-7535
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8386208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3162785Medicaid
TN3054411OtherBLUE CROSS BLUE SHIELD
TN3162785Medicaid