Provider Demographics
NPI:1326783820
Name:THOMAS, SYLVIA JIMMEL
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:JIMMEL
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 LOST LAKE WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-5350
Mailing Address - Country:US
Mailing Address - Phone:601-918-7578
Mailing Address - Fax:
Practice Address - Street 1:1230 RAYMOND RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-4583
Practice Address - Country:US
Practice Address - Phone:769-524-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty