MEDICARE: MARY GRACE THOMAS, PH.D.,P.C.

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
1	103T00000X	Psychologist	1806	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073848891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY GRACE THOMAS, PH.D.,P.C.

Provider Business Mailing Address
First Line	:	4411 SUWANEE DAM RD
Second Line	:	SUITE 920
City	:	SUWANEE
State	:	GA
Zip	:	30024-8701
Country	:	US
Telephone Number	:	678-714-9590
Fax Number	:	678-714-9535

Provider Business Practice Location Address
First Line	:	4411 SUWANEE DAM RD
Second Line	:	SUITE 920
City	:	SUWANEE
State	:	GA
Zip	:	30024-8701
Country	:	US
Telephone Number	:	678-714-9590
Fax Number	:	678-714-9535

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. MARY GRACE THOMAS
Credential	:	PH.D.
Telephone Number	:	678-714-9590

Provider Enumeration Date	:	10/13/2009
Last Update Date	:	10/13/2009

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Directions to “MARY GRACE THOMAS, PH.D.,P.C. ” Practice Location

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