Provider Demographics
NPI:1598795478
Name:TERRELL, GRACE EMERSON (MD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:EMERSON
Last Name:TERRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1701 WESTCHESTER DRIVE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2001
Practice Address - Street 1:1814 WESTCHESTER DR
Practice Address - Street 2:SUITE 301
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7369
Practice Address - Country:US
Practice Address - Phone:336-802-2025
Practice Address - Fax:336-802-2026
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC39340207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8982430Medicaid
NC110122229OtherRR MEDICARE
NC2183923CMedicare PIN
NC110122229OtherRR MEDICARE