Provider Demographics
NPI:1114020187
Name:HART, TERENCE THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:THOMAS
Last Name:HART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TERENCE
Other - Middle Name:T
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:PO BOX 2543
Mailing Address - Street 2:203 W AVALON AVE SUITE 390
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35662
Mailing Address - Country:US
Mailing Address - Phone:256-386-1105
Mailing Address - Fax:256-381-1018
Practice Address - Street 1:203 W AVALON AVE
Practice Address - Street 2:SUITE 390
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35662
Practice Address - Country:US
Practice Address - Phone:256-386-1105
Practice Address - Fax:256-381-1018
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7980207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
02765Medicare ID - Type Unspecified
C70118Medicare UPIN