Provider Demographics
NPI:1730144460
Name:TWILLIE, TWYLA (MD)
Entity Type:Individual
Prefix:DR
First Name:TWYLA
Middle Name:
Last Name:TWILLIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:901-300-5777
Mailing Address - Fax:
Practice Address - Street 1:1056 E RAINES RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6337
Practice Address - Country:US
Practice Address - Phone:901-300-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN021752207Q00000X
KY42589207Q00000X
OH35-094081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2959624Medicaid
WV3810015288Medicaid
KY7100077670Medicaid
OH4276911Medicare PIN
KY0586684Medicare PIN