MEDICARE: MS. DEMITRUS LASHAWN THOMAS RN, MSN, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN710329	GA

General Provider Information

NPI Number	:	1184297079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEMITRUS LASHAWN THOMAS RN, MSN, PMHNP-BC

Provider Business Mailing Address
First Line	:	175 CANVAS IVES DR
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30045-6744
Country	:	US
Telephone Number	:	864-344-6227
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 CANVAS IVES DR
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30045-6744
Country	:	US
Telephone Number	:	864-344-6227
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2021
Last Update Date	:	05/14/2026

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