Healthcare Provider Details

I. General information

NPI: 1003862905
Provider Name (Legal Business Name): SUZANNE DIXSON THOMAS APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 N LEG RD FAMILY HEALTH COORDINATOR, EAST CENTRAL HEALTH DISTRICT
AUGUSTA GA
30909-4402
US

IV. Provider business mailing address

300 GARDNERS MILL CT
AUGUSTA GA
30907-3716
US

V. Phone/Fax

Practice location:
  • Phone: 706-667-4285
  • Fax: 706-667-4607
Mailing address:
  • Phone: 706-651-0250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN101218 NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: