Provider Demographics
NPI:1881826600
Name:COLE, TERRY M (DPH)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:M
Last Name:COLE
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-8623
Mailing Address - Country:US
Mailing Address - Phone:931-552-2552
Mailing Address - Fax:931-551-8198
Practice Address - Street 1:1500 MADISON ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-8623
Practice Address - Country:US
Practice Address - Phone:931-552-2552
Practice Address - Fax:931-551-8198
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1528033842OtherBUSINESS NPI