Healthcare Provider Details

I. General information

NPI: 1689683765
Provider Name (Legal Business Name): DAVID JAMES TERRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST SUITE BP-4109
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

4 WINGED FOOT DR
MARTINEZ GA
30907-9140
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-6100
  • Fax: 706-721-0112
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number52028
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: