Provider Demographics
NPI:1184699662
Name:PHELPS, THOMAS F (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:PHELPS
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 1:156 MORGANS STEEP RD
Mailing Address - Street 2:
Mailing Address - City:SEWANEE
Mailing Address - State:TN
Mailing Address - Zip Code:37375-2031
Mailing Address - Country:US
Mailing Address - Phone:931-463-2014
Mailing Address - Fax:931-463-2014
Practice Address - Street 1:1750 CEDAR LN 300
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-4762
Practice Address - Country:US
Practice Address - Phone:931-393-7941
Practice Address - Fax:931-455-2272
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00018258207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB42656Medicare UPIN