Provider Demographics
NPI:1649222142
Name:LILLIS, TERENCE O (MD)
Entity type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:O
Last Name:LILLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:124 VERDAE BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3844
Mailing Address - Country:US
Mailing Address - Phone:864-315-1300
Mailing Address - Fax:
Practice Address - Street 1:1338 HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-5637
Practice Address - Country:US
Practice Address - Phone:864-297-7091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430044207Q00000X
SC87011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine