Provider Demographics
NPI:1952872780
Name:CHRISTOPHER, TERRI VANESSA
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:VANESSA
Last Name:CHRISTOPHER
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 1:1247 RUCKER BLVD STE 11
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-3630
Mailing Address - Country:US
Mailing Address - Phone:334-360-0438
Mailing Address - Fax:334-417-0040
Practice Address - Street 1:1247 RUCKER BLVD STE 11
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-3630
Practice Address - Country:US
Practice Address - Phone:334-360-0438
Practice Address - Fax:334-417-0040
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL47-4937774172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver