Provider Demographics
NPI:1407873060
Name:CROYLE, TERRENCE (MD)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:
Last Name:CROYLE
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 1:2282 E PINETREE BLVD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4807
Mailing Address - Country:US
Mailing Address - Phone:229-226-6000
Mailing Address - Fax:229-226-5859
Practice Address - Street 1:2375 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6517
Practice Address - Country:US
Practice Address - Phone:229-985-2020
Practice Address - Fax:229-890-7741
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034324207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000454319HOtherOPTICARE
GA354941OtherWELLCARE
GA000454319HOtherPEACH STATE
GA100621OtherAVESIS
GA964533OtherBLUE CROSS
GA000454319HMedicaid
P00247559OtherRAILROAD MEDICARE
582233896OtherHUMANA
GA000454319HMedicaid
GA354941OtherWELLCARE