Healthcare Provider Details

I. General information

NPI: 1972866887
Provider Name (Legal Business Name): TERA S CARR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERA N RETHFORD PA

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 TAYLOR RD
MONTGOMERY AL
36117-3513
US

IV. Provider business mailing address

3632 SIR MICHAEL DR
MONTGOMERY AL
36109-4433
US

V. Phone/Fax

Practice location:
  • Phone: 334-279-9333
  • Fax: 334-279-9057
Mailing address:
  • Phone: 229-733-3792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-831
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: