Healthcare Provider Details

I. General information

NPI: 1104873017
Provider Name (Legal Business Name): TERRY L FRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MARINA DR
GEORGETOWN SC
29440-2410
US

IV. Provider business mailing address

401 MARINA DR
GEORGETOWN SC
29440-2410
US

V. Phone/Fax

Practice location:
  • Phone: 843-546-7272
  • Fax: 843-546-0277
Mailing address:
  • Phone: 843-546-7272
  • Fax: 843-546-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number14277
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: