Provider Demographics
NPI:1063538718
Name:DOVER, TERRY HORTON (DPH)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:HORTON
Last Name:DOVER
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 GREEN ACRES DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-7023
Mailing Address - Country:US
Mailing Address - Phone:423-623-4067
Mailing Address - Fax:
Practice Address - Street 1:416 EASTERN PLAZA CENTER
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821
Practice Address - Country:US
Practice Address - Phone:423-623-9533
Practice Address - Fax:423-623-9414
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist