Provider Demographics
NPI:1558318964
Name:TERRY, NINA
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:TERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1801
Practice Address - Country:US
Practice Address - Phone:800-822-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL157672085R0202X
FLME648352085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009910263Medicaid
AL051541785OtherBCBS
AL51096525OtherBLUE CROSS BLUE SHIELD
AL051541786OtherBCBS
AL4067OtherTHE OATH
AL009910363Medicaid
AL051541788OtherBCBS
AL51096524OtherBLUE CROSS BLUE SHIELD
AL009910262Medicaid
AL051541790OtherBCBS
AL000024733Medicaid
AL051541787OtherBCBS
AL51024733OtherBLUE CROSS BLUE SHIELD
AL009910259Medicaid
AL009910261Medicaid
AL51096527OtherBLUE CROSS BLUE SHIELD
AL051541787OtherBCBS
AL051541785OtherBCBS
F69173Medicare UPIN