Healthcare Provider Details

I. General information

NPI: 1306586425
Provider Name (Legal Business Name): THOMAS GERALD CAUSEY JR. PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 WALNUT ST
WAYNESBORO MS
39367-2232
US

IV. Provider business mailing address

1304 WALNUT ST
WAYNESBORO MS
39367-2232
US

V. Phone/Fax

Practice location:
  • Phone: 601-735-9025
  • Fax:
Mailing address:
  • Phone: 601-735-9025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPTA4459
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: