Provider Demographics
NPI:1144553561
Name:BANKS, TERRY MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:MARIE
Last Name:BANKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:TERRY
Other - Middle Name:MARIE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:160 WENDOLYN TRCE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-7714
Mailing Address - Country:US
Mailing Address - Phone:770-719-3318
Mailing Address - Fax:
Practice Address - Street 1:160 WENDOLYN TRCE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-7714
Practice Address - Country:US
Practice Address - Phone:770-719-3318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0482062083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine