Individual
TERRY SUPANEE CHONGULIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
513 GREAT OAKS DR STE A, MONROE, GA 30655-8211
(770) 267-8368
(770) 207-0640
Mailing address
2370 HILLSIDE TRCE, MONROE, GA 30655-5880
(770) 267-0085
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
053640
GA
207V00000X
Obstetrics & Gynecology Physician
Primary
053640
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
443409802B
—
GA
01
—
52872342
BC/BS
GA
Enumeration date
09/14/2006
Last updated
02/01/2016
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