Skip to main content
Loading
Toggle search
Toggle navigation
Keyword Search
Join Now
Sign In
CONTACT
COVID-19
Membership
Toggle
Join Now
Services
Member Directory
Advocacy
Toggle
Legislative
Legal
Insurance
Grassroots
IMPACT
Education & Institute
Toggle
Online CME
CME Joint Providership
John Ingram Institute
Media
Toggle
News Releases
Events
Newsletter
Annual Report
About
Toggle
About Us
Leadership
Contact
Affiliate Partners
Local Medical Societies
Foundation
Medical Student Section
Spouses TMAA
MEDICAL RESIDENT MEMBERSHIP APPLICATION
The Tennessee Medical Association and its chartered component medical societies are organizations for physicians licensed to practice medicine in Tennessee who care about the quality, enjoyment and profitability of their practices and the integrity of the profession of medicine. Membership entitles you to all advocacy, education and professional development resources.
Personal Information
First Name
Required
Middle Name/Initial
Required
Last Name
Required
Date of Birth
February 2021
February 2021
S
M
T
W
T
F
S
6
31
1
2
3
4
5
6
7
7
8
9
10
11
12
13
8
14
15
16
17
18
19
20
9
21
22
23
24
25
26
27
10
28
1
2
3
4
5
6
11
7
8
9
10
11
12
13
Required
Suffix
I
II
III
IV
Jr.
Sr.
V
Gender
Female
Male
Required
Last 4 of SSN
Required
ADDRESS/COMMUNICATIONS INFORMATION
(Please select the preferred address for Association correspondence)
Preferred Address
Home
Office
Work Address
Company/Practice
Address 1
Address 2
Address 3
City
State
Armed Forces Americas
Armed Forces Africa, Canada, Europe, Middle East
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
Canal Zone
District of Columbia
Delaware
Florida
Georgia
Guam
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Zip
Office Phone
Fax
Home Address
Address 1
Address 2
Address 3
City
State
Armed Forces Americas
Armed Forces Africa, Canada, Europe, Middle East
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
Canal Zone
District of Columbia
Delaware
Florida
Georgia
Guam
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Zip
Phone
Medical Practice
Medical School
Required
Medical School Graduation Year
Designation
Doctor of Osteopathy
Medical Doctor
TN Medical License # (
if applicable
)
NPI # (
if applicable
)
Primary Specialty
A Allergy
ACA Adult Cardiothoracic Anesthesiology (Anesthesiology)
ADL Adolescent Medicine, Pediatrics
ADM Addiction Medicine
ADP Addiction Psychiatry
AI Allergy & Immunology
ALI Allergy/Immunology, Clin & Lab Immunology
AM Aerospace Medicine
AMF Adolescent Medicine, Family Practice
AMI Adolescent Medicine, Internal Medicine
AN Anesthesiology
APM Anesthesiology, Pain Medicine
AR Abdominal Radiology
AS Abdominal Surgery
ATP Pathology, Anatomic
BBK Pathology, Blood Bank/Transfusion Med.
CAP Child Abuse Pediatrics
CBG Clinical Biochemical Genetics
CCA Critical Care Medicine (Anesthesiology)
CCG Clinical Cytogenetics
CCM Internal Medicine, Critical Care Medicine
CCP Pediatric Critical Care
CCS Surgery, Critical Care
CD Cardiovascular Disease
CDS Surgery, Cardiovascular (Depreciated)
CFS Surgery, Craniofacial
CG Clinical Genetics
CHN Neurology, Child
CHP Psychiatry, Child & Adolescent
CHS Congenital Cardiac Surgery (Thoracic Surgery)
CLP Pathology, Clinical
CMG Genetics, Clinical Molecular
CN Neurology, Clinical Neurophysiology
CRS Colon & Rectal Surgery
CS Cosmetic Surgery
CTR Cardiothoracic Radiology
CTS Surgery, Cardiothoracic (Depreciated)
D Dermatology
DBP Developmental-Behavioral Pediatrics
DDL Dermatological Immun., Clin & Lab Immun.
DIA Diabetes
DMP Dermatopatholgy
DR Radiology, Diagnostic
DS Surgery, Dermatologic
EFM Emergency Medicine/Family Medicine
EM Emergency Medicine
EMP Pediatrics/Emergency Medicine
END Endocrinology, Diabetes & Metabolism
EP Epidemiology
ESM Emergency Medicine, Sports Medicine
ESN Endovascular Surgical Neuroradiology
ETX Emergency Medicine, Medical Toxicology
FLX Flexible Rotation (Depreciated)
FM Family Medicine
FOP Pathology, Forensic
FPG Family Practice, Geriatric Medicine
FPP Psychiatry/Family Medicine
FPS Surgery, Facial Plastic
FSM Family Practice, Sports Medicine
GE Gastroenterology
GO Gynecological Oncology
GP General Practice
GPM General Preventive Medicine
GS Surgery, General
GYN Gynecology
HEM Hematology
HEP Hepatology
HMP Pathology, Hematology
HNS Surgery, Head & Neck
HO Hematology/Oncology
HOS Hospitalist
HPA Hospice & Palliative Medicine (Anesthesiology)
HPD Hospice & Palliative Medicine (Radiology)
HPE Hospice & Palliative Medicine (Emergency Medicine)
HPF Hospice & Palliative Medicine (Family Medicine)
HPI Hospice & Palliative Medicine (Internal Medicine)
HPM Hospice & Palliative Medicine
HPN Hospice & Palliative Medicine (Psychiatry & Neurology)
HPO Hospice & Palliative Medicine (Obstetrics & Gynecology)
HPP Hospice & Palliative Medicine (Pediatrics)
HPR Hospice & Palliative Medicine (Physical Medicine & Rehabilitation)
HS Surgery, Hand
HSO Orthopedic Surgery, Hand Surgery
HSP Plastic Surgery, Hand Surgery
HSS Hand Surgery (Surgery)
IC Cardiology, Interventional
ICE Cardiac Electrophsyiology, Clinical
ID Infectious Diseases
IEC Internal Med/Emergency Med/Critical Care Med
IFP Internal Medicine/Family Practice
IG Immunology
ILI Internal Med, Clin & Lab Immunology
IM Internal Medicine
IMD Internal Medicine/Dermatology
IMG Internal Medicine, Geriatrics
INM Internal Medicine/Nuclear Medicine
IPM Internal Medicine/Preventive Medicine
ISM Internal Medicine, Sports Medicine
LM Legal Medicine
MDM Medical Management
MFM Maternal and Fetal Medicine
MG Genetics, Medical
MGG Genetics, Molecular Genetic Pathology
MGP Pathology, Molecular Genetic Pathology
MM Medical Microbiology
MP Internal Med/Psychiatry
MPD Internal Medicine, Pediatrics
MPM Internal Med/Phys Med And Rehabilitation
MSR Musculoskeletal Radiology
N Neurology
NC Nuclear Cardiology
NDN Neurodevelopmental Disabilities Psychiatry & Neurology
NDP Neurodevelopmental Disabilities, Pediatrics
NEP Nephrology
NM Nuclear Medicine
NMN Neuromuscular Medicine (Neurology)
NMP Neuromuscular Medicine (Physical Medicine & Rehabilitation)
NNM Neurology/Nuclear Medicine
NO Otology/Neurotology
NP Pathology, Neuropathology
NPM Neonatal-Perinatal Medicine
NPR Neurology/Physical Medicine And Rehabilitation
NR Nuclear Radiology
NRN Neurology, Diag Rad, Neuroradiology
NS Surgery, Neurological
NSP Surgery, Pediatric Neurology
NTR Nutrition
NUP Neuropsychiatry
OAR Adult Reconstructive, Orthopedic
OBG Obstetrics and Gynecology
OBS Obstetrics
OCC Obstetrics/Gynecology, Critical Care Medicine
OFA Foot and Ankle Orthopedics
OM Occupational Medicine
OMF Oral & Maxillfacial Surgery
OMM Osteopathic Manipulative Medicine
OMO Orthopedic, Musculoskeletal Oncology
ON Oncology
OP Pediatric Orthopedic
OPH Ophthalmology
ORS Surgery, Orthopedic
OS Other Specialty
OSM Surgery, Orthopedic Sports Medicine
OSS Surgery, Orthopedic Spine
OT Otology (Depreciated)
OTO Otolaryngology
OTR Orthopedic, Trauma
P Psychiatry
PA Pharmacology, Clinical
PAN Pediatric Anesthesiology
PCC Pulmonary Critical Care Medicine
PCH Pathology, Chemical
PCP Pathology, Cytopathology
PCS Surgery, Pediatric Cardiothoracic
PD Pediatrics
PDA Pediatric Allergy
PDC Pediatric Cardiology
PDD Pediatric Dermatology
PDE Pediatric Endocrinology
PDI Pediatric Infectious Diseases
PDM Pediatrics/Dermatology
PDO Pediatric Otolaryngology
PDP Pediatric Pulmonology
PDR Radiology, Pediatric
PDS Surgery, Pediatric
PDT Pediatric Medical Toxicology
PE Emergency Medicine, Pediatric Emergency Medicine
PEM Pediatric, Pediatric Emergency Medicine
PFP Psychiatry, Forensic
PG Pediatric Gastroenterology
PHM Pharmaceutical Medicine
PHO Pediatric Hematology-Oncology
PHP Public Health & General Preventive Medicine
PLI Pediatric Clin & Lab Immunology
PLM Palliative Medicine
PM Physical Medicine and Rehabilitation
PMD Pain Medicine (Depreciated)
PME Pain Management
PMG Pediatrics/Medical Genetics
PMM Physical Medicine & Rehab, Sports Medicine
PMN Pain Medicine (Neurology)
PMP Pain Medicine (Physical Medicine & Rehabilitation)
PN Pediatric Nephrology
PO Pediatric Ophthalmology
PP Pediatric Pathology
PPM Pediatrics/Physical Medicine And Rehabilitation
PPN Pain Medicine (Psychiatry)
PPR Pediatric Rheumatology
PRD Procedural Dermatology
PRM Pediatric Rehabilitation Medicine
PRO Proctology
PRS Sports Medicine (Physical Medicine & Rehabilitation)
PS Surgery, Plastic
PSH Surgery, Plastic within the Head & Neck
PSM Pediatric Sports Medicine
PSO Plastic Surgery Within The Head & Neck (Otolaryngology)
PSP Plastic Surgery Within The Head & Neck (Plastic Surgery)
PTH Pathology, Anatomical/Clinical
PTP Pediatric Transplant Hepatology
PTX Preventive Medicine, Medical Toxicology
PUD Pulmonary Diseases
PYA Psychoanalysis
PYG Psychiatry, Geriatrics
PYM Psychosomatic Medicine
PYN Psychiatry/Neurology
R Radiology
REN Reproductive Endocrinology
RHU Rheumatology
RNR Neuroradiology
RO Radiation Oncology
RP Radiological Physics
RPM Pediatric Rehabilitation Medicine
SCI Spinal Cord Injury
SME Sleep Medicine
SMN Sleep Medicine (Psychiatry & Neurology)
SMO Sleep Medicine (Otolaryngology)
SMP Sleep Medicine (Pediatrics)
SO Surgical Oncology
SP Selective Pathology
THP Transplant Hepatology (Internal Medicine)
TMP Temporary (to be assigned)
TRS Surgery, Trauma
TS Surgery, Thoracic
TTS Surgery, Transplant
U Urology
UCM Urgent Care Medicine
UM Undersea & Hyperbaric Medicine
UME Underseas Medicine (Emergency Medicine)
UNK Unknown
UP Pediatric Urology
US Unspecified
VIR Radiology, Vascular & Interventional
VM Vascular Medicine
VN Vascular Neurology
VS Surgery, Vascular
Secondary Specialty
A Allergy
ACA Adult Cardiothoracic Anesthesiology (Anesthesiology)
ADL Adolescent Medicine, Pediatrics
ADM Addiction Medicine
ADP Addiction Psychiatry
AI Allergy & Immunology
ALI Allergy/Immunology, Clin & Lab Immunology
AM Aerospace Medicine
AMF Adolescent Medicine, Family Practice
AMI Adolescent Medicine, Internal Medicine
AN Anesthesiology
APM Anesthesiology, Pain Medicine
AR Abdominal Radiology
AS Abdominal Surgery
ATP Pathology, Anatomic
BBK Pathology, Blood Bank/Transfusion Med.
CAP Child Abuse Pediatrics
CBG Clinical Biochemical Genetics
CCA Critical Care Medicine (Anesthesiology)
CCG Clinical Cytogenetics
CCM Internal Medicine, Critical Care Medicine
CCP Pediatric Critical Care
CCS Surgery, Critical Care
CD Cardiovascular Disease
CDS Surgery, Cardiovascular (Depreciated)
CFS Surgery, Craniofacial
CG Clinical Genetics
CHN Neurology, Child
CHP Psychiatry, Child & Adolescent
CHS Congenital Cardiac Surgery (Thoracic Surgery)
CLP Pathology, Clinical
CMG Genetics, Clinical Molecular
CN Neurology, Clinical Neurophysiology
CRS Colon & Rectal Surgery
CS Cosmetic Surgery
CTR Cardiothoracic Radiology
CTS Surgery, Cardiothoracic (Depreciated)
D Dermatology
DBP Developmental-Behavioral Pediatrics
DDL Dermatological Immun., Clin & Lab Immun.
DIA Diabetes
DMP Dermatopatholgy
DR Radiology, Diagnostic
DS Surgery, Dermatologic
EFM Emergency Medicine/Family Medicine
EM Emergency Medicine
EMP Pediatrics/Emergency Medicine
END Endocrinology, Diabetes & Metabolism
EP Epidemiology
ESM Emergency Medicine, Sports Medicine
ESN Endovascular Surgical Neuroradiology
ETX Emergency Medicine, Medical Toxicology
FLX Flexible Rotation (Depreciated)
FM Family Medicine
FOP Pathology, Forensic
FPG Family Practice, Geriatric Medicine
FPP Psychiatry/Family Medicine
FPS Surgery, Facial Plastic
FSM Family Practice, Sports Medicine
GE Gastroenterology
GO Gynecological Oncology
GP General Practice
GPM General Preventive Medicine
GS Surgery, General
GYN Gynecology
HEM Hematology
HEP Hepatology
HMP Pathology, Hematology
HNS Surgery, Head & Neck
HO Hematology/Oncology
HOS Hospitalist
HPA Hospice & Palliative Medicine (Anesthesiology)
HPD Hospice & Palliative Medicine (Radiology)
HPE Hospice & Palliative Medicine (Emergency Medicine)
HPF Hospice & Palliative Medicine (Family Medicine)
HPI Hospice & Palliative Medicine (Internal Medicine)
HPM Hospice & Palliative Medicine
HPN Hospice & Palliative Medicine (Psychiatry & Neurology)
HPO Hospice & Palliative Medicine (Obstetrics & Gynecology)
HPP Hospice & Palliative Medicine (Pediatrics)
HPR Hospice & Palliative Medicine (Physical Medicine & Rehabilitation)
HS Surgery, Hand
HSO Orthopedic Surgery, Hand Surgery
HSP Plastic Surgery, Hand Surgery
HSS Hand Surgery (Surgery)
IC Cardiology, Interventional
ICE Cardiac Electrophsyiology, Clinical
ID Infectious Diseases
IEC Internal Med/Emergency Med/Critical Care Med
IFP Internal Medicine/Family Practice
IG Immunology
ILI Internal Med, Clin & Lab Immunology
IM Internal Medicine
IMD Internal Medicine/Dermatology
IMG Internal Medicine, Geriatrics
INM Internal Medicine/Nuclear Medicine
IPM Internal Medicine/Preventive Medicine
ISM Internal Medicine, Sports Medicine
LM Legal Medicine
MDM Medical Management
MFM Maternal and Fetal Medicine
MG Genetics, Medical
MGG Genetics, Molecular Genetic Pathology
MGP Pathology, Molecular Genetic Pathology
MM Medical Microbiology
MP Internal Med/Psychiatry
MPD Internal Medicine, Pediatrics
MPM Internal Med/Phys Med And Rehabilitation
MSR Musculoskeletal Radiology
N Neurology
NC Nuclear Cardiology
NDN Neurodevelopmental Disabilities Psychiatry & Neurology
NDP Neurodevelopmental Disabilities, Pediatrics
NEP Nephrology
NM Nuclear Medicine
NMN Neuromuscular Medicine (Neurology)
NMP Neuromuscular Medicine (Physical Medicine & Rehabilitation)
NNM Neurology/Nuclear Medicine
NO Otology/Neurotology
NP Pathology, Neuropathology
NPM Neonatal-Perinatal Medicine
NPR Neurology/Physical Medicine And Rehabilitation
NR Nuclear Radiology
NRN Neurology, Diag Rad, Neuroradiology
NS Surgery, Neurological
NSP Surgery, Pediatric Neurology
NTR Nutrition
NUP Neuropsychiatry
OAR Adult Reconstructive, Orthopedic
OBG Obstetrics and Gynecology
OBS Obstetrics
OCC Obstetrics/Gynecology, Critical Care Medicine
OFA Foot and Ankle Orthopedics
OM Occupational Medicine
OMF Oral & Maxillfacial Surgery
OMM Osteopathic Manipulative Medicine
OMO Orthopedic, Musculoskeletal Oncology
ON Oncology
OP Pediatric Orthopedic
OPH Ophthalmology
ORS Surgery, Orthopedic
OS Other Specialty
OSM Surgery, Orthopedic Sports Medicine
OSS Surgery, Orthopedic Spine
OT Otology (Depreciated)
OTO Otolaryngology
OTR Orthopedic, Trauma
P Psychiatry
PA Pharmacology, Clinical
PAN Pediatric Anesthesiology
PCC Pulmonary Critical Care Medicine
PCH Pathology, Chemical
PCP Pathology, Cytopathology
PCS Surgery, Pediatric Cardiothoracic
PD Pediatrics
PDA Pediatric Allergy
PDC Pediatric Cardiology
PDD Pediatric Dermatology
PDE Pediatric Endocrinology
PDI Pediatric Infectious Diseases
PDM Pediatrics/Dermatology
PDO Pediatric Otolaryngology
PDP Pediatric Pulmonology
PDR Radiology, Pediatric
PDS Surgery, Pediatric
PDT Pediatric Medical Toxicology
PE Emergency Medicine, Pediatric Emergency Medicine
PEM Pediatric, Pediatric Emergency Medicine
PFP Psychiatry, Forensic
PG Pediatric Gastroenterology
PHM Pharmaceutical Medicine
PHO Pediatric Hematology-Oncology
PHP Public Health & General Preventive Medicine
PLI Pediatric Clin & Lab Immunology
PLM Palliative Medicine
PM Physical Medicine and Rehabilitation
PMD Pain Medicine (Depreciated)
PME Pain Management
PMG Pediatrics/Medical Genetics
PMM Physical Medicine & Rehab, Sports Medicine
PMN Pain Medicine (Neurology)
PMP Pain Medicine (Physical Medicine & Rehabilitation)
PN Pediatric Nephrology
PO Pediatric Ophthalmology
PP Pediatric Pathology
PPM Pediatrics/Physical Medicine And Rehabilitation
PPN Pain Medicine (Psychiatry)
PPR Pediatric Rheumatology
PRD Procedural Dermatology
PRM Pediatric Rehabilitation Medicine
PRO Proctology
PRS Sports Medicine (Physical Medicine & Rehabilitation)
PS Surgery, Plastic
PSH Surgery, Plastic within the Head & Neck
PSM Pediatric Sports Medicine
PSO Plastic Surgery Within The Head & Neck (Otolaryngology)
PSP Plastic Surgery Within The Head & Neck (Plastic Surgery)
PTH Pathology, Anatomical/Clinical
PTP Pediatric Transplant Hepatology
PTX Preventive Medicine, Medical Toxicology
PUD Pulmonary Diseases
PYA Psychoanalysis
PYG Psychiatry, Geriatrics
PYM Psychosomatic Medicine
PYN Psychiatry/Neurology
R Radiology
REN Reproductive Endocrinology
RHU Rheumatology
RNR Neuroradiology
RO Radiation Oncology
RP Radiological Physics
RPM Pediatric Rehabilitation Medicine
SCI Spinal Cord Injury
SME Sleep Medicine
SMN Sleep Medicine (Psychiatry & Neurology)
SMO Sleep Medicine (Otolaryngology)
SMP Sleep Medicine (Pediatrics)
SO Surgical Oncology
SP Selective Pathology
THP Transplant Hepatology (Internal Medicine)
TMP Temporary (to be assigned)
TRS Surgery, Trauma
TS Surgery, Thoracic
TTS Surgery, Transplant
U Urology
UCM Urgent Care Medicine
UM Undersea & Hyperbaric Medicine
UME Underseas Medicine (Emergency Medicine)
UNK Unknown
UP Pediatric Urology
US Unspecified
VIR Radiology, Vascular & Interventional
VM Vascular Medicine
VN Vascular Neurology
VS Surgery, Vascular
Practice County
Anderson
Bedford
Benton
Bledsoe
Blount
Bradley
Campbell
Cannon
Carroll
Carter
Cheatham
Chester
Claiborne
Clay
Cocke
Coffee
Crockett
Cumberland
Davidson
Decatur
Dekalb
Dickson
Dyer
Fayette
Fentress
Franklin
Gibson
Giles
Grainger
Greene
Grundy
Hamblen
Hamilton
Hancock
Hardeman
Hardin
Hawkins
Haywood
Henderson
Henry
Hickman
Houston
Humphreys
Jackson
Jefferson
Johnson
Knox
Lake
Lauderdale
Lawrence
Lewis
Lincoln
Loudon
Macon
Madison
Marion
Marshall
Maury
McMinn
McNairy
Meigs
Monroe
Montgomery
Moore
Morgan
Obion
Overton
Perry
Pickett
Polk
Putnam
Rhea
Roane
Robertson
Rutherford
Scott
Select County of Practice
Sequatchie
Sevier
Shelby
Smith
Stewart
Sullivan
Sumner
Tipton
Trousdale
Unicoi
Union
Van Buren
Warren
Washington
Wayne
Weakley
White
Williamson
Wilson
Log In
Email
Username
Password (minimum 6 characters)
Confirm Password
Type the code from the image
Confirm delete
Are you sure you want to delete this record?
Confirm delete
Are you sure you want to delete this record?
{1}
##LOC[OK]##
{1}
##LOC[OK]##
##LOC[Cancel]##
{1}
##LOC[OK]##
##LOC[Cancel]##