Provider Demographics
NPI:1457539082
Name:TENNIS, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:TENNIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1027A EDGEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3205
Mailing Address - Country:US
Mailing Address - Phone:864-227-9708
Mailing Address - Fax:864-229-5542
Practice Address - Street 1:1027A EDGEFIELD ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3205
Practice Address - Country:US
Practice Address - Phone:864-227-9708
Practice Address - Fax:864-229-5542
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC10951207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine