MEDICARE: SHERISE THOMAS DDS

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	122300000X	Dentist	DN015387	GA

General Provider Information

NPI Number	:	1740640598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERISE THOMAS DDS

Provider Business Mailing Address
First Line	:	2118 MARSHALLS LN SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-2825
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	970 MARTIN LUTHER KING JR DR SW STE 301
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30314-2962
Country	:	US
Telephone Number	:	678-631-8116
Fax Number	:

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

Provider Enumeration Date	:	03/07/2016
Last Update Date	:	10/24/2017

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Directions to “ SHERISE THOMAS DDS” Practice Location

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