Healthcare Provider Details

I. General information

NPI: 1043451800
Provider Name (Legal Business Name): MS. THESUS O'NEAL-THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 35TH ST
TUSCALOOSA AL
35401-6138
US

IV. Provider business mailing address

6615 35TH ST
TUSCALOOSA AL
35401-6138
US

V. Phone/Fax

Practice location:
  • Phone: 205-759-5365
  • Fax:
Mailing address:
  • Phone: 205-759-5365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: