Healthcare Provider Details

I. General information

NPI: 1700806437
Provider Name (Legal Business Name): GEORGE WESLEY THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 ASHLEY CIR
BOWLING GREEN KY
42104-3362
US

IV. Provider business mailing address

PO BOX 51065
BOWLING GREEN KY
42102-4365
US

V. Phone/Fax

Practice location:
  • Phone: 270-793-2165
  • Fax:
Mailing address:
  • Phone: 270-393-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number18568
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: