Healthcare Provider Details

I. General information

NPI: 1124090279
Provider Name (Legal Business Name): TERRY DOUGLAS HESS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 LEWISVILLE CLEMMONS RD DBA FAMILY MEDICAL ASSOCIATES OF LEWISVILLE
LEWISVILLE NC
27023-8251
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 336-712-0700
  • Fax: 336-712-0876
Mailing address:
  • Phone: 336-712-0700
  • Fax: 336-712-0876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34543
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: