Individual
AMILIE T THAMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1110 BROAD AVE STE 700, GULFPORT, MS 39501-8908
(228) 864-0314
(228) 868-8435
Mailing address
PO BOX 1810, GULFPORT, MS 39502-1810
(228) 575-1194
(228) 575-2917
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
16575
MS
207R00000X
Internal Medicine Physician
21067
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011846
GROUP PAYEE MEDICARE NUMBER
AL
01
—
1063439065
GROUP PAYEE NPI NUMBER
AL
05
—
630000013
—
AL
Enumeration date
08/15/2006
Last updated
11/10/2021
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