MEDICARE: THOMAS B. MUDD PHARMD.

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	183500000X	Pharmacist	43175	TN
2	183500000X	Pharmacist	24751	NC
3	183500000X	Pharmacist	RPH028374	GA
4	183500000X	Pharmacist	PS42646	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24751	OTHER	NC	NORTH CAROLINA BOARD OF PHARMACY
2	43175	OTHER	TN	TENNESSEE BOARD OF PHARMACY
3	PS42646	OTHER	FL	FLORIDA BOARD OF PHARMACY
4	RPH028374	OTHER	GA	GEORGIA BOARD OF PHARMACY

General Provider Information

NPI Number	:	1669945515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS B. MUDD PHARMD.

Provider Business Mailing Address
First Line	:	1155 BATTLEFIELD PKWY
Second Line	:
City	:	FORT OGLETHORPE
State	:	GA
Zip	:	30742-3960
Country	:	US
Telephone Number	:	762-887-6046
Fax Number	:	762-887-6050

Provider Business Practice Location Address
First Line	:	1155 BATTLEFIELD PKWY
Second Line	:
City	:	FORT OGLETHORPE
State	:	GA
Zip	:	30742-3960
Country	:	US
Telephone Number	:	762-887-6046
Fax Number	:	762-887-6050

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

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	05/21/2023

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Directions to “ THOMAS B. MUDD PHARMD.” Practice Location

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