Healthcare Provider Details

I. General information

NPI: 1780095794
Provider Name (Legal Business Name): JAMILA NATALIE THOMAS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MCDONOUGH BLVD SE
ATLANTA GA
30315-4400
US

IV. Provider business mailing address

PO BOX 81
STONE MOUNTAIN GA
30072
US

V. Phone/Fax

Practice location:
  • Phone: 404-635-5100
  • Fax:
Mailing address:
  • Phone: 678-478-2758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: