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General NPI Number Information
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NPI Number | 1881688968
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Entity Type | Individual
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Provider Name | WAYNE ERIC THOMAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/06/2005
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Last Update Date | 01/24/2008
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Provider Practice Location Address
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Address Line | 2828 HIGHWAY 31 S SUITE 109
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City | DECATUR
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State | AL
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Zip | 35603-1510
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Country | US
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Telephone | 256-351-1591
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Fax | 256-351-1596
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Provider Business Mailing Address
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Address Line | 2828 HIGHWAY 31 S SUITE 109
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City | DECATUR
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State | AL
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Zip | 35603-1510
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Country | US
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Telephone | 256-351-1591
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 00014586
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License Number State | AL
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