Provider Demographics
NPI:1992183115
Name:TERESA PATTERSON MD
Entity Type:Organization
Organization Name:TERESA PATTERSON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-455-2525
Mailing Address - Street 1:209 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3353
Mailing Address - Country:US
Mailing Address - Phone:931-455-2525
Mailing Address - Fax:931-455-2505
Practice Address - Street 1:209 WILSON AVE
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3353
Practice Address - Country:US
Practice Address - Phone:931-455-2525
Practice Address - Fax:931-455-2505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD9548207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2008461OtherBLUE CROSS BLUE SHIELD OF TENNESSEE