Provider Demographics
NPI:1700868221
Name:PERRY, TERILYN CASSANDRA (MD)
Entity Type:Individual
Prefix:
First Name:TERILYN
Middle Name:CASSANDRA
Last Name:PERRY
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:PO BOX 1140
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31902-1140
Mailing Address - Country:US
Mailing Address - Phone:706-660-1200
Mailing Address - Fax:706-660-0060
Practice Address - Street 1:3655 GURLEY DR STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6886
Practice Address - Country:US
Practice Address - Phone:706-660-1200
Practice Address - Fax:706-660-0060
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA35974208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000511684AMedicaid