MEDICARE: DR. TEDRA CAROLYN THOMAS MD

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	207Q00000X	Family Medicine Physician	89557	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821586645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TEDRA CAROLYN THOMAS MD

Provider Business Mailing Address
First Line	:	PO BOX 4363
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31208-4363
Country	:	US
Telephone Number	:	478-787-4266
Fax Number	:	478-787-4199

Provider Business Practice Location Address
First Line	:	730 GLYNN ST S
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-2050
Country	:	US
Telephone Number	:	770-460-3650
Fax Number	:

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

Provider Enumeration Date	:	04/26/2018
Last Update Date	:	08/21/2025

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