Provider Demographics
NPI:1184455008
Name:GILES, TERRANCE D DWAYNE JR
Entity type:Individual
Prefix:
First Name:TERRANCE D
Middle Name:DWAYNE
Last Name:GILES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S HEIGHTS BLVD APT 1113
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-5855
Mailing Address - Country:US
Mailing Address - Phone:318-278-7407
Mailing Address - Fax:
Practice Address - Street 1:201 S HEIGHTS BLVD APT 1113
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-5855
Practice Address - Country:US
Practice Address - Phone:318-278-7407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator