Healthcare Provider Details

I. General information

NPI: 1942234380
Provider Name (Legal Business Name): THOMAS F BYARS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 PROFESSIONAL DR STE 550
LAWRENCEVILLE GA
30046-3356
US

IV. Provider business mailing address

575 PROFESSIONAL DR STE 550
LAWRENCEVILLE GA
30046-3356
US

V. Phone/Fax

Practice location:
  • Phone: 855-647-7678
  • Fax: 404-847-4488
Mailing address:
  • Phone: 855-647-7678
  • Fax: 404-847-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD39135
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberMD39135
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD39135
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number59689
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: