Provider Demographics
NPI:1952572828
Name:TERRELL, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:TERRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 NACOOCHEE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-1823
Mailing Address - Country:US
Mailing Address - Phone:706-546-7908
Mailing Address - Fax:706-546-1944
Practice Address - Street 1:150 NACOOCHEE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-1823
Practice Address - Country:US
Practice Address - Phone:770-853-2743
Practice Address - Fax:706-546-1944
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003654231H00000X
SC3931237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3931OtherSTATE LICENSE
SCQ358375449Medicare PIN