Healthcare Provider Details

I. General information

NPI: 1245297209
Provider Name (Legal Business Name): THOMAS JUDE UNGARINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 13TH AVENUE
ALBANY GA
31701
US

IV. Provider business mailing address

PO BOX 72105
ALBANY GA
31708-2105
US

V. Phone/Fax

Practice location:
  • Phone: 229-438-5864
  • Fax: 229-438-1004
Mailing address:
  • Phone: 229-438-5864
  • Fax: 229-438-1004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number043799
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number043799
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: