Provider Demographics
NPI:1891768040
Name:HYATT, TERRI L (MD)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:HYATT
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:PO BOX 1000, DEPT 19
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-259-9200
Mailing Address - Fax:901-362-6618
Practice Address - Street 1:2996 KATE BOND RD
Practice Address - Street 2:STE 405
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4030
Practice Address - Country:US
Practice Address - Phone:901-386-4423
Practice Address - Fax:901-333-8056
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19764207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3047108Medicare ID - Type Unspecified
TNC72152Medicare UPIN