Healthcare Provider Details

I. General information

NPI: 1114777125
Provider Name (Legal Business Name): JANICE THOMAS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 COLUMBIA PKWY
DECATUR GA
30034-3349
US

IV. Provider business mailing address

3540 COLUMBIA PKWY
DECATUR GA
30034-3349
US

V. Phone/Fax

Practice location:
  • Phone: 678-836-4908
  • Fax:
Mailing address:
  • Phone: 678-836-4908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number06225312
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: