Healthcare Provider Details

I. General information

NPI: 1043281207
Provider Name (Legal Business Name): THOMAS F DECKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5354 REYNOLDS ST STE 102
SAVANNAH GA
31405-6007
US

IV. Provider business mailing address

5354 REYNOLDS ST SUITE 102
SAVANNAH GA
31405-6007
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-2116
  • Fax: 912-355-3653
Mailing address:
  • Phone: 912-355-2116
  • Fax: 912-355-3653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number035851
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number16324
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number035851
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number035851
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP00334799
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerRR MCARE-SCI
# 2
Identifier908957800
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer
# 3
IdentifierG35851
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 4
Identifier000511585
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 5
Identifier300029144
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerRR MCARE-CRP
# 6
IdentifierP00866848
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerRR MCARE-OIS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: