MEDICARE: GEORGE W. THOMAS D.D.S., 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	1223G0001X	General Practice Dentistry	7259	GA

General Provider Information

NPI Number	:	1114941184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE W. THOMAS D.D.S., P.C.

Provider Business Mailing Address
First Line	:	1600 ALICE ST
Second Line	:
City	:	WAYCROSS
State	:	GA
Zip	:	31501-4533
Country	:	US
Telephone Number	:	912-285-3140
Fax Number	:	912-285-0260

Provider Business Practice Location Address
First Line	:	1600 ALICE ST
Second Line	:
City	:	WAYCROSS
State	:	GA
Zip	:	31501-4533
Country	:	US
Telephone Number	:	912-285-3140
Fax Number	:	912-285-0260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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