Healthcare Provider Details

I. General information

NPI: 1629110549
Provider Name (Legal Business Name): GEALON A THOMAS DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 PEACOCK COURT
SEYMOUR TN
37865
US

IV. Provider business mailing address

111 PEACOCK COURT
SEYMOUR TN
37865
US

V. Phone/Fax

Practice location:
  • Phone: 865-573-0274
  • Fax: 865-577-0174
Mailing address:
  • Phone: 865-573-0274
  • Fax: 865-577-0174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. GEALON A THOMAS
Title or Position: OWNER PRESIDENT
Credential: DDS
Phone: 865-573-0274