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General NPI Number Information
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NPI Number | 1154574721
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Entity Type | Individual
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Provider Name | JERRY JASON THOMAS DDS
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Gender | Male
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 8200 MALL PKWY STE 200
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City | LITHONIA
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State | GA
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Zip | 30038-6983
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Country | US
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Telephone | 770-484-7645
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Fax | 770-484-7745
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Provider Business Mailing Address
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Address Line | 4724 EAGLES RIDGE LOOP
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City | LITHONIA
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State | GA
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Zip | 30038-3537
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Country | US
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Telephone | 770-484-7645
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Fax | 770-484-7745
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN012642
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2901018052
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License Number State | MI
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