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General NPI Number Information
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NPI Number | 1376914184
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Entity Type | Individual
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Provider Name | JOLLY THOMAS
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Gender | Female
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Dates
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Enumeration Date | 10/20/2015
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Last Update Date | 12/23/2021
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Provider Practice Location Address
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Address Line | 1000 MEDICAL CENTER BLVD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-7694
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Country | US
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Telephone | 678-312-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 GRAYSON HWY APT 1905
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City | GRAYSON
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State | GA
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Zip | 30017-1907
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Country | US
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Telephone | 267-237-4350
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | SP015375
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN285678
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN587335
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License Number State | PA
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