Healthcare Provider Details

I. General information

NPI: 1558304576
Provider Name (Legal Business Name): GLENN C. TERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 SANDY PARKWAY BLDG 2 STE Q
COLUMBUS GA
31909
US

IV. Provider business mailing address

3021 SANDY PKWY BLDG 2 STE Q
COLUMBUS GA
31909-1695
US

V. Phone/Fax

Practice location:
  • Phone: 706-503-5057
  • Fax:
Mailing address:
  • Phone: 706-503-5057
  • Fax: 706-243-4277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number22896
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number022896
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: