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NPI Code Detail

MEDICARE: DR. JACK THOMAS JR. DDS

MEDICARE: DR. JACK THOMAS JR. DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0221XPediatric DentistryDN011911GA
2122300000XDentistDN011911GA

General Provider Information

NPI Number : 1043247257
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACK THOMAS JR. DDS
Provider Business Mailing Address
First Line : 5461 MERIDIAN MARK RD STE 200
Second Line :
City : ATLANTA
State : GA
Zip : 30342-4014
Country : US
Telephone Number : 404-785-2072
Fax Number : 404-785-5892
Provider Business Practice Location Address
First Line : 5461 MERIDIAN MARK RD STE 200
Second Line :
City : ATLANTA
State : GA
Zip : 30342-4014
Country : US
Telephone Number : 404-785-2072
Fax Number : 404-785-5892
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2006
Last Update Date : 07/12/2024

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Directions to “ DR. JACK THOMAS JR. DDS” Practice Location

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