Provider Demographics
NPI:1972866887
Name:CARR, TERA S (PA)
Entity Type:Individual
Prefix:
First Name:TERA
Middle Name:S
Last Name:CARR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TERA
Other - Middle Name:N
Other - Last Name:RETHFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3632 SIR MICHAEL DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-4433
Mailing Address - Country:US
Mailing Address - Phone:229-733-3792
Mailing Address - Fax:
Practice Address - Street 1:495 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3513
Practice Address - Country:US
Practice Address - Phone:334-279-9333
Practice Address - Fax:334-279-9057
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-831363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant