Provider Demographics
NPI:1376637025
Name:TREADWELL, TERRY A (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:A
Last Name:TREADWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BROWN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7005
Mailing Address - Country:US
Mailing Address - Phone:334-747-4159
Mailing Address - Fax:
Practice Address - Street 1:2167 NORMANDIE DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2728
Practice Address - Country:US
Practice Address - Phone:334-747-3444
Practice Address - Fax:334-747-3450
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11176208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051531984 529929310Medicaid
AL1710077OtherUNITED HEALTH CARE
ALC71058OtherVIVA
AL203204949OtherFED TAX ID
AL203204949OtherHEALTH CHOICE
ALC71058 31984OtherBLUE CROSS SHIELD
ALC71058 31984OtherBLUE CROSS SHIELD