Healthcare Provider Details

I. General information

NPI: 1265532808
Provider Name (Legal Business Name): NADINE AMERICAN THOMAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NADINE KARLENA AMERICAN M.D.

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

772 MADDOX DR STE 122
EAST ELLIJAY GA
30540-8196
US

IV. Provider business mailing address

165 BLUE RIDGE OVERLOOK
BLUE RIDGE GA
30513-4431
US

V. Phone/Fax

Practice location:
  • Phone: 706-635-6898
  • Fax: 706-635-6885
Mailing address:
  • Phone: 706-946-5602
  • Fax: 706-374-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number63743
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: