Provider Demographics
NPI:1326628959
Name:TERRY, DWAYNE LUKE (MD)
Entity type:Individual
Prefix:
First Name:DWAYNE
Middle Name:LUKE
Last Name:TERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5150 STILESBORO RD NW STE 120
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7741
Mailing Address - Country:US
Mailing Address - Phone:678-354-0230
Mailing Address - Fax:678-354-0828
Practice Address - Street 1:5150 STILESBORO RD NW STE 120
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7741
Practice Address - Country:US
Practice Address - Phone:678-354-0230
Practice Address - Fax:678-354-0828
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA99963207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine