Provider Demographics
NPI:1528067337
Name:THAXTON, ANDREA M (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:M
Last Name:THAXTON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:881 USS JAMES MADISON RD
Mailing Address - Street 2:
Mailing Address - City:KINGS BAY
Mailing Address - State:GA
Mailing Address - Zip Code:31547-2531
Mailing Address - Country:US
Mailing Address - Phone:912-573-8801
Mailing Address - Fax:912-573-2597
Practice Address - Street 1:881 USS JAMES MADISON RD
Practice Address - Street 2:
Practice Address - City:KINGS BAY
Practice Address - State:GA
Practice Address - Zip Code:31547-2531
Practice Address - Country:US
Practice Address - Phone:912-573-4220
Practice Address - Fax:912-573-2597
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2023-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME88475208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267766100Medicaid