Individual
MR. TERRELL THOMPSON UNDERWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.D.O.
Contact information
Practice address
805 COMMERCE DR SW, SUITE A, CONYERS, GA 30094-6606
(770) 483-4831
(770) 483-4840
Mailing address
805 COMMERCE DR SW, SUITE A, CONYERS, GA 30094-6606
(770) 483-4831
(770) 483-4840
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
LDO000310
GA
Other
Enumeration date
02/22/2007
Last updated
07/09/2007
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