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NPI Code Detail

MEDICARE: TESSIE THOMAS DO

MEDICARE: TESSIE THOMAS DO
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
1207Q00000XFamily Medicine Physician55574GA

General Provider Information

NPI Number : 1053417949
Entity Type Code : Individual
Provider Name (Legal Business Name) : TESSIE THOMAS DO
Provider Business Mailing Address
First Line : 2870 PHARR COURT SOUTH NW
Second Line : UNIT 1707
City : ATLANTA
State : GA
Zip : 30305-2174
Country : US
Telephone Number : 215-806-6500
Fax Number :
Provider Business Practice Location Address
First Line : 30 WARREN ST SE
Second Line :
City : ATLANTA
State : GA
Zip : 30317-2267
Country : US
Telephone Number : 404-616-9304
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2006
Last Update Date : 09/26/2019

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Directions to “ TESSIE THOMAS DO” Practice Location

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