1558082297 NPI number — DR. CHRISTIAN TERRY PHD

Table of content: DR. CHRISTIAN TERRY PHD (NPI 1558082297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558082297 NPI number — DR. CHRISTIAN TERRY PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TERRY
Provider First Name:
CHRISTIAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TERRY
Provider Other First Name:
CHRIS
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1558082297
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4415 JUNCTION PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28412-2263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-791-6277
Provider Business Mailing Address Fax Number:
910-791-6226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4415 JUNCTION PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28412-2263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-791-6277
Provider Business Practice Location Address Fax Number:
910-791-6226
Provider Enumeration Date:
09/12/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)