Healthcare Provider Details

I. General information

NPI: 1043985963
Provider Name (Legal Business Name): JOYCE L TERRELL ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 08/12/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WEST END WELL WERKS, LLC 1062 RALPH DAVID ABERNATHY BLVD SW
ATLANTA GA
30310-1812
US

IV. Provider business mailing address

524 WATERFORD RD NW
ATLANTA GA
30318-7145
US

V. Phone/Fax

Practice location:
  • Phone: 678-471-4615
  • Fax: 404-921-9233
Mailing address:
  • Phone: 678-471-4615
  • Fax: 404-921-9233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number049502533
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: