Healthcare Provider Details

I. General information

NPI: 1013368430
Provider Name (Legal Business Name): ADELA CASTRO GUTIERREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 MADISON AVE
MEMPHIS TN
38103-3409
US

IV. Provider business mailing address

1107 MEMORIAL DR STE 100
DALTON GA
30720-8662
US

V. Phone/Fax

Practice location:
  • Phone: 901-545-7259
  • Fax: 901-515-9286
Mailing address:
  • Phone: 706-529-3072
  • Fax: 706-529-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number70426
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number87568
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: