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General NPI Number Information
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NPI Number | 1740298967
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Entity Type | Individual
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Provider Name | TERRENCE JOHN MILLETTE MD
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Gender | Male
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 3616 HOSPITAL ST SUITE A
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City | PASCAGOULA
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State | MS
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Zip | 39581-4117
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Country | US
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Telephone | 228-990-9926
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1030
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City | PASCAGOULA
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State | MS
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Zip | 39568-1030
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Country | US
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Telephone | 228-990-9926
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MS09641
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MS09641
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 01077142A
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License Number State | IN
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