Healthcare Provider Details

I. General information

NPI: 1679344303
Provider Name (Legal Business Name): THOMAS JAMES WNDOWS MT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1534 DAWSON RD
ALBANY GA
31707-3437
US

IV. Provider business mailing address

1534 DAWSON RD
ALBANY GA
31707-3437
US

V. Phone/Fax

Practice location:
  • Phone: 229-435-9008
  • Fax:
Mailing address:
  • Phone: 229-435-9008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT014813
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: