Healthcare Provider Details

I. General information

NPI: 1831131671
Provider Name (Legal Business Name): EDWARD LEE GIAROLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 CROSSOVER ROAD
TUPELO MS
38801-4944
US

IV. Provider business mailing address

POST OFFICE BOX 980
TUPELO MS
38802-0980
US

V. Phone/Fax

Practice location:
  • Phone: 662-620-7102
  • Fax: 662-620-7106
Mailing address:
  • Phone: 662-620-7102
  • Fax: 662-620-7106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number16635
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: