MEDICARE: MR. THOMAS J WIEME PA-C

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	363A00000X	Physician Assistant	1768	GA

General Provider Information

NPI Number	:	1427207422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS J WIEME PA-C

Provider Business Mailing Address
First Line	:	3736 MIKE PADGETT HWY
Second Line	:	SUITE A
City	:	AUGUSTA
State	:	GA
Zip	:	30906-0719
Country	:	US
Telephone Number	:	706-560-2273
Fax Number	:	706-560-0903

Provider Business Practice Location Address
First Line	:	3736 MIKE PADGETT HWY
Second Line	:	SUITE A
City	:	AUGUSTA
State	:	GA
Zip	:	30906-0719
Country	:	US
Telephone Number	:	706-560-2273
Fax Number	:	706-560-0903

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

Provider Enumeration Date	:	09/15/2008
Last Update Date	:	09/15/2008

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