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General NPI Number Information
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NPI Number | 1750237129
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Entity Type | Individual
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Provider Name | ANGELIQUE THOMAS
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Gender | Female
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Dates
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Enumeration Date | 03/09/2026
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Last Update Date | 03/09/2026
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Provider Practice Location Address
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Address Line | 3072 SABLE RUN RD
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City | ATLANTA
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State | GA
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Zip | 30349-3658
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Country | US
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Telephone | 404-988-8137
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Fax |
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Provider Business Mailing Address
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Address Line | 6404 PROPNEY WAY
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City | UNION CITY
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State | GA
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Zip | 30291-1623
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Country | US
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Telephone | 404-988-8137
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN250899
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License Number State | GA
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