Provider Demographics
NPI:1730159591
Name:THOMAS, EDDIE D (MD)
Entity type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 PEACHTREE ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-0304
Mailing Address - Country:US
Mailing Address - Phone:912-530-7337
Mailing Address - Fax:912-530-7339
Practice Address - Street 1:391 PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0245
Practice Address - Country:US
Practice Address - Phone:912-530-7337
Practice Address - Fax:912-530-7339
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053192208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA798956032AMedicaid