Provider Demographics
NPI:1356158893
Name:TERRELL, EMANUEL
Entity type:Individual
Prefix:
First Name:EMANUEL
Middle Name:
Last Name:TERRELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TERRELL
Other - Middle Name:TRUCKING
Other - Last Name:SERVICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:31 OAK TREE DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5714
Mailing Address - Country:US
Mailing Address - Phone:504-905-8881
Mailing Address - Fax:
Practice Address - Street 1:31 OAK TREE DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-5714
Practice Address - Country:US
Practice Address - Phone:504-905-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty