Provider Demographics
NPI:1336107119
Name:BINGHAM, TERRY MARSHALL (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:MARSHALL
Last Name:BINGHAM
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 1:1855 TANNER WAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-8302
Mailing Address - Country:US
Mailing Address - Phone:865-882-2442
Mailing Address - Fax:865-882-0251
Practice Address - Street 1:1855 TANNER WAY
Practice Address - Street 2:SUITE 220
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8302
Practice Address - Country:US
Practice Address - Phone:865-882-2442
Practice Address - Fax:865-882-0251
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND10262208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ012240Medicaid