Provider Demographics
NPI:1558361345
Name:HENSON, TERRI HAYES (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:HAYES
Last Name:HENSON
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 1:7585 CLARINGTON CV
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-5656
Mailing Address - Country:US
Mailing Address - Phone:662-349-0200
Mailing Address - Fax:662-349-1666
Practice Address - Street 1:7585 CLARINGTON CV
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5656
Practice Address - Country:US
Practice Address - Phone:662-349-0200
Practice Address - Fax:662-349-1666
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16501207N00000X
TN25961207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9015946Medicaid
G51423Medicare UPIN
MS070000088Medicare ID - Type Unspecified