MEDICARE: CEPHAS V THOMASON III D.D.S.

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	1223P0221X	Pediatric Dentistry	GA6924	GA

General Provider Information

NPI Number	:	1306955612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CEPHAS V THOMASON III D.D.S.

Provider Business Mailing Address
First Line	:	3623 CALVIN DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-7915
Country	:	US
Telephone Number	:	706-327-6262
Fax Number	:	706-327-1250

Provider Business Practice Location Address
First Line	:	3623 CALVIN DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-7915
Country	:	US
Telephone Number	:	706-327-6262
Fax Number	:	706-327-1250

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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