Provider Demographics
NPI:1407193014
Name:TERRY, LATERA D
Entity type:Individual
Prefix:
First Name:LATERA
Middle Name:D
Last Name:TERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 DEKALB MEDICAL PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-4933
Mailing Address - Country:US
Mailing Address - Phone:404-446-3870
Mailing Address - Fax:
Practice Address - Street 1:771 OLD NORCROSS RD STE 225
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4982
Practice Address - Country:US
Practice Address - Phone:678-802-4045
Practice Address - Fax:770-407-2059
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8448207R00000X, 207P00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine