Healthcare Provider Details

I. General information

NPI: 1831023217
Provider Name (Legal Business Name): MARLYN MOLTON THOMAS MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 NORTHSIDE DR
MACON GA
31210-2404
US

IV. Provider business mailing address

120 WESTFAUL DR
MACON GA
31216-6164
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-4206
  • Fax:
Mailing address:
  • Phone: 478-952-0322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN287394
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: