Provider Demographics
NPI:1679505853
Name:MCMILLIN, TERRY Y (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:Y
Last Name:MCMILLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 9TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-4015
Mailing Address - Country:US
Mailing Address - Phone:662-459-1367
Mailing Address - Fax:662-459-1368
Practice Address - Street 1:203 9TH ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-4015
Practice Address - Country:US
Practice Address - Phone:662-459-1367
Practice Address - Fax:662-459-1368
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS207V00000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117104Medicaid
MS13194OtherSTATE LICENSING
MSF82198Medicare UPIN