Provider Demographics
NPI:1821376476
Name:BYARS, TERRI MELISSA (ACNP)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:MELISSA
Last Name:BYARS
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:MELISSA
Other - Last Name:CULPEPPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1825 MARTHA BERRY BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1625
Mailing Address - Country:US
Mailing Address - Phone:706-295-5331
Mailing Address - Fax:
Practice Address - Street 1:504 REDMOND RD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1416
Practice Address - Country:US
Practice Address - Phone:706-235-3855
Practice Address - Fax:706-290-2382
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN149469363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003112514CMedicaid
GA202I506945Medicare PIN