Healthcare Provider Details

I. General information

NPI: 1891798492
Provider Name (Legal Business Name): GEOGY THOMAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 03/07/2023
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 SUNSET TRL
JELLICO TN
37762-2343
US

IV. Provider business mailing address

PO BOX 540
JELLICO TN
37762-0540
US

V. Phone/Fax

Practice location:
  • Phone: 423-784-5771
  • Fax: 423-784-6185
Mailing address:
  • Phone: 423-784-8492
  • Fax: 423-784-8358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35929
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34083
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: