Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 63743 | GA |
NPI | 1265532808 |
---|---|
Provider Name | Mrs. Nadine American Thomas |
First Address | Blue Ridge, GA 30513-4431 |
Second Address | East Ellijay, GA 30540-8196 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2006 |
Last Update Date | 13/12/2021 |