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NPI Code Detail

MEDICARE: TERRY MICHAEL DEAKLE PA

MEDICARE: TERRY MICHAEL DEAKLE PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant00543NC

General Provider Information

NPI Number : 1326028382
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY MICHAEL DEAKLE PA
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6301 STADIUM DR
Second Line :
City : CLEMMONS
State : NC
Zip : 27012-8766
Country : US
Telephone Number : 336-766-6473
Fax Number : 336-766-8909
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2006
Last Update Date : 06/10/2024

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Directions to “ TERRY MICHAEL DEAKLE PA” Practice Location

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