Healthcare Provider Details

I. General information

NPI: 1326783820
Provider Name (Legal Business Name): SYLVIA JIMMEL THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 RAYMOND RD
JACKSON MS
39204-4583
US

IV. Provider business mailing address

3919 LOST LAKE WAY
JACKSON MS
39212-5350
US

V. Phone/Fax

Practice location:
  • Phone: 769-524-8002
  • Fax:
Mailing address:
  • Phone: 601-918-7578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: