MEDICARE: DR. JAMES AUGUSTUS THOMAS D.MIN, L.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	101YP2500X	Professional Counselor	6736	NC

General Provider Information

NPI Number	:	1215119276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES AUGUSTUS THOMAS D.MIN, L.P.C.

Provider Business Mailing Address
First Line	:	3733 OGBURN AVE
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-3753
Country	:	US
Telephone Number	:	336-767-2776
Fax Number	:

Provider Business Practice Location Address
First Line	:	3733 OGBURN AVE
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-3753
Country	:	US
Telephone Number	:	336-767-2776
Fax Number	:

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

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	12/03/2007

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