Provider Demographics
NPI:1932120672
Name:HOLDREDGE, TERRY KEENE (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:KEENE
Last Name:HOLDREDGE
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 1:3031 N HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-3621
Mailing Address - Country:US
Mailing Address - Phone:864-226-7371
Mailing Address - Fax:864-226-8367
Practice Address - Street 1:3031 N HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3621
Practice Address - Country:US
Practice Address - Phone:864-226-7371
Practice Address - Fax:864-226-8367
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC78072086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC078070Medicaid
SCB922952682Medicare ID - Type Unspecified
SC078070Medicaid