Provider Demographics
NPI:1922099399
Name:STONE, TERRELL LEE (MD)
Entity Type:Individual
Prefix:
First Name:TERRELL
Middle Name:LEE
Last Name:STONE
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 743294
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3294
Mailing Address - Country:US
Mailing Address - Phone:864-365-0200
Mailing Address - Fax:864-365-0205
Practice Address - Street 1:10 ENTERPRISE BLVD STE 111
Practice Address - Street 2:COVENANT INTERNAL MEDICINE
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3534
Practice Address - Country:US
Practice Address - Phone:864-365-0200
Practice Address - Fax:864-365-0205
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC135838Medicaid
SC135838Medicaid
SCSC89208157Medicare PIN
SC4399101OtherAETNA PROVIDER NUMBER
SCF23872Medicare UPIN