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General NPI Number Information
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NPI Number | 1538699442
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Entity Type | Individual
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Provider Name | ROBERT GLYNN THOMAS III LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/13/2017
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Last Update Date | 06/13/2017
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Provider Practice Location Address
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Address Line | 8046 ROSWELL RD STE 101C
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City | SANDY SPRINGS
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State | GA
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Zip | 30350-3930
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Country | US
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Telephone | 404-434-6305
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Fax |
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Provider Business Mailing Address
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Address Line | 4417 IVYWOOD DR
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City | MARIETTA
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State | GA
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Zip | 30062-6434
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Country | US
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Telephone | 404-434-6305
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW005531
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License Number State | GA
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