Provider Demographics
NPI:1659335669
Name:TERRY, CAROL A (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:A
Last Name:TERRY
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 1:363 SWANSON DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-8533
Mailing Address - Country:US
Mailing Address - Phone:770-995-5558
Mailing Address - Fax:770-995-6746
Practice Address - Street 1:363 SWANSON DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-8533
Practice Address - Country:US
Practice Address - Phone:770-995-5558
Practice Address - Fax:770-995-6746
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035341207ZF0201X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G43654Medicare UPIN