Provider Demographics
NPI:1790845303
Name:LAMBERT, TERRY R (DC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:R
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 BARROW AVE SW
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:GA
Mailing Address - Zip Code:31779-2131
Mailing Address - Country:US
Mailing Address - Phone:229-294-3091
Mailing Address - Fax:229-294-3060
Practice Address - Street 1:423 BARROW AVE SW
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:GA
Practice Address - Zip Code:31779-2131
Practice Address - Country:US
Practice Address - Phone:229-294-3091
Practice Address - Fax:229-294-3060
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000873012AMedicaid
GA000873012AMedicaid
GA352CFRJMedicare ID - Type Unspecified