Provider Demographics
NPI:1518096098
Name:CAUDILL, TERRA C (MD)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:C
Last Name:CAUDILL
Suffix:
Gender:F
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:PO BOX 601372
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1372
Mailing Address - Country:US
Mailing Address - Phone:704-444-2400
Mailing Address - Fax:704-358-2716
Practice Address - Street 1:501 BILLINGSLEY RD
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1009
Practice Address - Country:US
Practice Address - Phone:704-444-2400
Practice Address - Fax:704-358-2716
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-009732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2256Medicaid
NC1518096098Medicaid
NCNCL038AMedicare PIN