Provider Demographics
NPI:1164559738
Name:PEDIGO, THOMAS K (EDD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:K
Last Name:PEDIGO
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 MALL BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4864
Mailing Address - Country:US
Mailing Address - Phone:912-349-4055
Mailing Address - Fax:912-244-6500
Practice Address - Street 1:450 MALL BLVD STE E
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4864
Practice Address - Country:US
Practice Address - Phone:912-349-4055
Practice Address - Fax:912-244-6500
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002145103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00767786BMedicaid