Healthcare Provider Details

I. General information

NPI: 1104868959
Provider Name (Legal Business Name): THOMAS N. BERNARD JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6262 VETERANS PKWY
COLUMBUS GA
31909-3540
US

IV. Provider business mailing address

6262 VETERANS PKWY
COLUMBUS GA
31909-3540
US

V. Phone/Fax

Practice location:
  • Phone: 706-324-6661
  • Fax: 706-327-6701
Mailing address:
  • Phone: 706-324-6661
  • Fax: 706-327-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number024391
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: