Provider Demographics
NPI:1518517507
Name:TERRY, EDDIE JAMES
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:JAMES
Last Name:TERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HEADS AVE
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3616
Mailing Address - Country:US
Mailing Address - Phone:229-931-2493
Mailing Address - Fax:
Practice Address - Street 1:100 HEADS AVE
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3616
Practice Address - Country:US
Practice Address - Phone:229-931-2493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker