Provider Demographics
NPI:1992810691
Name:THIEL, ADELE A (MD)
Entity type:Individual
Prefix:DR
First Name:ADELE
Middle Name:A
Last Name:THIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5500
Mailing Address - Fax:601-984-5503
Practice Address - Street 1:1020 RIVER OAKS DR
Practice Address - Street 2:SUITE 420
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9500
Practice Address - Country:US
Practice Address - Phone:601-939-4198
Practice Address - Fax:601-939-4120
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS121612084N0400X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09013832Medicaid
MS130010501OtherRAILROAD MEDICARE
MS0114179Medicaid
MS130010501OtherRAILROAD MEDICARE
MS0114179Medicaid