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General NPI Number Information
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NPI Number | 1073848891
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Entity Type | Organization
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Legal Business Name | MARY GRACE THOMAS, PH.D.,P.C.
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Dates
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Enumeration Date | 10/13/2009
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Last Update Date | 10/13/2009
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Provider Practice Location Address
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Address Line | 4411 SUWANEE DAM RD SUITE 920
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City | SUWANEE
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State | GA
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Zip | 30024-8701
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Country | US
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Telephone | 678-714-9590
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Fax | 678-714-9535
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Provider Business Mailing Address
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Address Line | 4411 SUWANEE DAM RD SUITE 920
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City | SUWANEE
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State | GA
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Zip | 30024-8701
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Country | US
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Telephone | 678-714-9590
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Fax | 678-714-9535
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. MARY GRACE THOMAS
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Credential | PH.D.
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Telephone | 678-714-9590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1806
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License Number State | GA
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