Provider Demographics
NPI:1457555690
Name:TERENCE T HART, MD, PA
Entity Type:Organization
Organization Name:TERENCE T HART, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-386-1105
Mailing Address - Street 1:203 AVALON AVE
Mailing Address - Street 2:SUITE 390
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-2869
Mailing Address - Country:US
Mailing Address - Phone:256-386-1105
Mailing Address - Fax:256-381-1018
Practice Address - Street 1:203 AVALON AVE
Practice Address - Street 2:SUITE 390
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2869
Practice Address - Country:US
Practice Address - Phone:256-386-1105
Practice Address - Fax:256-381-1018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7980261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC70118Medicare UPIN