=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508933003
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERRY WAYNE BENTLEY M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2006
-----------------------------------------------------
Last Update Date | 10/26/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 MEDICAL CENTER DR STE 300
-----------------------------------------------------
City | JASPER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35501-3428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-384-0141
-----------------------------------------------------
Fax | 205-384-0171
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 MEDICAL CENTER DR STE 300
-----------------------------------------------------
City | JASPER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35501-3428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-384-0141
-----------------------------------------------------
Fax | 205-384-0171
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 16128
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 00016128
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------