Provider Demographics
NPI:1255981403
Name:CALDWELL, TERENCE CHEVEZ (TRANSPORTATION)
Entity type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:CHEVEZ
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:TRANSPORTATION
Other - Prefix:MR
Other - First Name:TERENCE
Other - Middle Name:CHEVEZ
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TRANSPORTATION
Mailing Address - Street 1:1154 SHARONTON DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-5323
Mailing Address - Country:US
Mailing Address - Phone:404-484-5409
Mailing Address - Fax:
Practice Address - Street 1:1154 SHARONTON DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-5323
Practice Address - Country:US
Practice Address - Phone:404-781-5768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor