Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 00000000000000000000 | GA |
Y | 208600000X | Surgeon | 00000000000000000000 | GA |
N | 208200000X | Surgeon | 00000000000000000000 | MD |
N | 208600000X | Surgeon | 00000000000000000000 | MD |
NPI | 1013392471 |
---|---|
Provider Name | Samantha Courtney Thomas |
First Address | Baltimore, MD 21229-5201 |
Second Address | Atlanta, GA 30303-5201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2015 |
Last Update Date | 08/04/2021 |