MEDICARE: PERRY M. 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	048732	GA
2	207P00000X	Emergency Medicine Physician	048732	GA

General Provider Information

NPI Number	:	1922168103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PERRY M. THOMAS MD

Provider Business Mailing Address
First Line	:	861 SW 78TH AVE
Second Line	:	SUITE # 100-B
City	:	PLANTATION
State	:	FL
Zip	:	33324-3273
Country	:	US
Telephone Number	:	954-693-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 MOUNTAIN DR
Second Line	:
City	:	DAHLONEGA
State	:	GA
Zip	:	30533-1606
Country	:	US
Telephone Number	:	706-867-4140
Fax Number	:

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	10/20/2011

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