Provider Demographics
NPI:1144485624
Name:FERRELL, THAD HAGAN (MD)
Entity type:Individual
Prefix:DR
First Name:THAD
Middle Name:HAGAN
Last Name:FERRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7730 WOLF RIVER BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1708
Mailing Address - Country:US
Mailing Address - Phone:901-755-9211
Mailing Address - Fax:901-755-9232
Practice Address - Street 1:7730 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1708
Practice Address - Country:US
Practice Address - Phone:901-755-9211
Practice Address - Fax:901-755-9232
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD8409208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3163852Medicare UPIN