Individual
TERRELL SEAN TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BOCP, CO
Contact information
Practice address
1661 INTERNATIONAL DRIVE, SUITE 400, MEMPHIS, TN 38120-1431
(901) 340-2008
Mailing address
1661 INTERNATIONAL PLACE DR STE 400, MEMPHIS, TN 38120-1431
(901) 818-3175
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
PRO130
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PRO130
TN DEPT OF HEALTH DIVISION OF RELATED BOARDS
TN
Enumeration date
04/11/2018
Last updated
05/28/2021
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