Provider Demographics
NPI:1144500117
Name:ANN DRAKE THOMAS M.D.,P.C.
Entity type:Organization
Organization Name:ANN DRAKE THOMAS M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:DRAKE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:7707-943-3341
Mailing Address - Street 1:670 CANTON RD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8952
Mailing Address - Country:US
Mailing Address - Phone:770-794-3341
Mailing Address - Fax:770-590-0379
Practice Address - Street 1:670 CANTON RD NE
Practice Address - Street 2:SUITE A
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8952
Practice Address - Country:US
Practice Address - Phone:770-794-3341
Practice Address - Fax:770-590-0379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care