Provider Demographics
NPI:1487866158
Name:MEADOWS, TERRY ANN (DO)
Entity type:Individual
Prefix:MS
First Name:TERRY
Middle Name:ANN
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 K & B LANE
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111
Mailing Address - Country:US
Mailing Address - Phone:601-469-4151
Mailing Address - Fax:
Practice Address - Street 1:330 NORTH BROAD ST
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074
Practice Address - Country:US
Practice Address - Phone:601-469-4151
Practice Address - Fax:601-469-3681
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10554261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0010446Medicaid
MS930003170Medicare ID - Type Unspecified
MSF53325Medicare UPIN