Provider Demographics
NPI:1861919284
Name:THOMAS, JAMAINE RUPERT (PA)
Entity type:Individual
Prefix:MR
First Name:JAMAINE
Middle Name:RUPERT
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:5505 PEACHTREE DUNWOODY RD STE 600
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1717
Mailing Address - Country:US
Mailing Address - Phone:404-355-0743
Mailing Address - Fax:855-286-3226
Practice Address - Street 1:5505 PEACHTREE DUNWOODY RD STE 600
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1717
Practice Address - Country:US
Practice Address - Phone:404-355-0743
Practice Address - Fax:855-286-3226
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA12462363A00000X
MO2020010247363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220092402Medicaid