Healthcare Provider Details

I. General information

NPI: 1992810691
Provider Name (Legal Business Name): ADELE A THIEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 RIVER OAKS DR SUITE 420
FLOWOOD MS
39232-9500
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 601-939-4198
  • Fax: 601-939-4120
Mailing address:
  • Phone: 601-984-5500
  • Fax: 601-984-5503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number12161
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number12161
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: