Provider Demographics
NPI:1457871949
Name:TERRY, AMY MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:TERRY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 AIRPORT ROAD
Mailing Address - Street 2:#101
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721
Mailing Address - Country:US
Mailing Address - Phone:706-275-4444
Mailing Address - Fax:
Practice Address - Street 1:1200 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2529
Practice Address - Country:US
Practice Address - Phone:423-240-3965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA223960363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily