Provider Demographics
NPI:1639141674
Name:JOHNS, TERRANCE PERCELL (MD)
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:PERCELL
Last Name:JOHNS
Suffix:
Gender:M
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 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-475-8121
Mailing Address - Fax:336-475-5377
Practice Address - Street 1:309 PINEYWOOD RD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-3438
Practice Address - Country:US
Practice Address - Phone:336-475-8121
Practice Address - Fax:336-475-5377
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401424207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8946457Medicaid
BJ3439519OtherFEDERAL DEA
NC2204051DMedicare PIN
F46674Medicare UPIN
NC2204051CMedicare PIN
NC2204051BMedicare PIN