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General NPI Number Information
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NPI Number | 1508628868
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Entity Type | Individual
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Provider Name | ANTHONY DAVIS TERRY
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Gender | Male
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Dates
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Enumeration Date | 01/23/2024
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 2360 S LINDEN RD
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City | FLINT
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State | MI
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Zip | 48532-5483
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Country | US
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Telephone | 810-720-2913
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Fax |
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Provider Business Mailing Address
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Address Line | 2215 FULLER RD
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City | ANN ARBOR
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State | MI
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Zip | 48105-2303
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Country | US
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Telephone | 734-769-7100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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