Provider Demographics
NPI:1699714311
Name:PITTS, TERRY (DO)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:
Last Name:PITTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-4243
Mailing Address - Country:US
Mailing Address - Phone:601-428-0577
Mailing Address - Fax:601-649-7962
Practice Address - Street 1:1440 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4243
Practice Address - Country:US
Practice Address - Phone:601-428-0577
Practice Address - Fax:601-649-7962
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115316Medicaid
MSF22503Medicare UPIN
MS080003666Medicare Oscar/Certification
MS302I081416Medicare Oscar/Certification