Individual
THOMAS G BANNISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5384 POPLAR AVE, SUITE 106, MEMPHIS, TN 38119-3609
(901) 255-3030
(901) 507-7811
Mailing address
5384 POPLAR AVE, SUITE 106, MEMPHIS, TN 38119-3609
(901) 255-3030
(901) 507-7811
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
25198
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3081700
—
TN
Enumeration date
08/24/2006
Last updated
01/16/2009
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