Healthcare Provider Details

I. General information

NPI: 1508129438
Provider Name (Legal Business Name): VENYETTE THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

896 HIGHWAY 81 E
MCDONOUGH GA
30252-2914
US

IV. Provider business mailing address

6381 ZEBULON RD
MACON GA
31220-2601
US

V. Phone/Fax

Practice location:
  • Phone: 404-948-3019
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN192517
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN192517
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: