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General NPI Number Information
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NPI Number | 1871851162
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Entity Type | Organization
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Legal Business Name | REGIONAL NEONATAL SPECIALISTS PLLC
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Dates
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Enumeration Date | 04/25/2012
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 1200 MEMORIAL DR
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City | DALTON
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State | GA
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Zip | 30720-2529
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Country | US
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Telephone | 706-272-6490
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Fax | 706-272-6491
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Provider Business Mailing Address
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Address Line | PO BOX 2645
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City | DALTON
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State | GA
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Zip | 30722-2645
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Country | US
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Telephone | 706-272-6490
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Fax | 706-272-6491
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Authorized Official
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Title or Position | OWNER
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Name | VICTOR THOMAS
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Credential | MD
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Telephone | 706-272-6490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number |
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License Number State |
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