Provider Demographics
NPI:1770763351
Name:JOHN S. THOMAS, M.D.
Entity type:Organization
Organization Name:JOHN S. THOMAS, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-382-3888
Mailing Address - Street 1:962 JOE FRANK HARRIS PKWY SE
Mailing Address - Street 2:STE 206
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2142
Mailing Address - Country:US
Mailing Address - Phone:770-382-3888
Mailing Address - Fax:770-382-3828
Practice Address - Street 1:962 JOE FRANK HARRIS PKWY SE
Practice Address - Street 2:STE 206
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2142
Practice Address - Country:US
Practice Address - Phone:770-382-3888
Practice Address - Fax:770-382-3828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047671174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6302OtherMEDICARE GROUP NUMBER
GAGRP6302OtherMEDICARE GROUP NUMBER