Provider Demographics
NPI:1740317833
Name:NEUROLOGY ASSOCIATES OF MS
Entity type:Organization
Organization Name:NEUROLOGY ASSOCIATES OF MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-769-0276
Mailing Address - Street 1:3101 DENNY AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5307
Mailing Address - Country:US
Mailing Address - Phone:228-769-0276
Mailing Address - Fax:228-762-0504
Practice Address - Street 1:4105 HOSPITAL ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5312
Practice Address - Country:US
Practice Address - Phone:228-769-0276
Practice Address - Fax:228-762-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02965Medicare ID - Type Unspecified