Provider Demographics
NPI:1699272351
Name:BOX, TERRA LYNN
Entity type:Individual
Prefix:
First Name:TERRA
Middle Name:LYNN
Last Name:BOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERRA
Other - Middle Name:LYNN
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2620 HOUGH RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1747
Mailing Address - Country:US
Mailing Address - Phone:256-284-7080
Mailing Address - Fax:205-614-6522
Practice Address - Street 1:2620 HOUGH RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1747
Practice Address - Country:US
Practice Address - Phone:256-284-7080
Practice Address - Fax:205-614-6522
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator