MEDICARE: MR. TOMAS J CHAO PA

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	363AM0700X	Medical Physician Assistant	3497	GA

General Provider Information

NPI Number	:	1316003577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TOMAS J CHAO PA

Provider Business Mailing Address
First Line	:	100 STONEFOREST DR
Second Line	:	SUITE 320
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-4880
Country	:	US
Telephone Number	:	770-516-5199
Fax Number	:	770-516-5188

Provider Business Practice Location Address
First Line	:	100 STONEFOREST DR
Second Line	:	SUITE 320
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-4880
Country	:	US
Telephone Number	:	770-516-5199
Fax Number	:	770-516-5188

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

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	05/19/2015

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