Healthcare Provider Details

I. General information

NPI: 1427459585
Provider Name (Legal Business Name): THOMAS DUMAIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 HARMON AVE
APO AA
31314
US

IV. Provider business mailing address

411 E 9TH ST # 54
FORT STEWART GA
31314-5036
US

V. Phone/Fax

Practice location:
  • Phone: 912-435-6965
  • Fax:
Mailing address:
  • Phone: 401-480-6492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code246YR1600X
TaxonomyRegistered Record Administrator
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: