MEDICARE: MR. JAMAINE RUPERT THOMAS 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	363A00000X	Physician Assistant	12462	GA

General Provider Information

NPI Number	:	1861919284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMAINE RUPERT THOMAS PA

Provider Business Mailing Address
First Line	:	5505 PEACHTREE DUNWOODY RD STE 600
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1717
Country	:	US
Telephone Number	:	404-355-0743
Fax Number	:	855-286-3226

Provider Business Practice Location Address
First Line	:	5505 PEACHTREE DUNWOODY RD STE 600
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1717
Country	:	US
Telephone Number	:	404-355-0743
Fax Number	:	855-286-3226

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

Provider Enumeration Date	:	08/25/2017
Last Update Date	:	09/09/2024

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