Healthcare Provider Details

I. General information

NPI: 1013515717
Provider Name (Legal Business Name): THOMAS EADES PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 COLLEGE STATION RD
ATHENS GA
30605-6609
US

IV. Provider business mailing address

2301 COLLEGE STATION RD
ATHENS GA
30605-6609
US

V. Phone/Fax

Practice location:
  • Phone: 706-353-6882
  • Fax: 706-357-5459
Mailing address:
  • Phone: 706-353-6882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH021227
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: