Healthcare Provider Details

I. General information

NPI: 1407939564
Provider Name (Legal Business Name): THOMASVILLE FAMILY MEDICINE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 S BROAD ST
THOMASVILLE GA
31792-6161
US

IV. Provider business mailing address

951 S BROAD ST
THOMASVILLE GA
31792-6161
US

V. Phone/Fax

Practice location:
  • Phone: 229-228-4130
  • Fax: 229-226-4690
Mailing address:
  • Phone: 229-228-4130
  • Fax: 229-226-4690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number002549
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number019585
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number029087
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number045799
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number046526
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number033433
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number067205
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number067559
License Number StateGA

VIII. Authorized Official

Name: CALVIN J REAMS
Title or Position: PARTNER
Credential: MD
Phone: 229-228-4130