Healthcare Provider Details

I. General information

NPI: 1104701648
Provider Name (Legal Business Name): TERRI GRYGIER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11530 HIGHWAY 49 STE E
GULFPORT MS
39503-3089
US

IV. Provider business mailing address

4125 SILVERWOOD DR
OCEAN SPRINGS MS
39564-3083
US

V. Phone/Fax

Practice location:
  • Phone: 228-707-2007
  • Fax:
Mailing address:
  • Phone: 228-382-8634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: