Provider Demographics
NPI:1003087024
Name:JOSEPH S THOMAS M D
Entity Type:Organization
Organization Name:JOSEPH S THOMAS M D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:229-242-9565
Mailing Address - Street 1:410 CONNELL RD
Mailing Address - Street 2:STE T
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1407
Mailing Address - Country:US
Mailing Address - Phone:229-242-9565
Mailing Address - Fax:229-242-1725
Practice Address - Street 1:410 CONNELL RD
Practice Address - Street 2:STE T
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1407
Practice Address - Country:US
Practice Address - Phone:229-242-9565
Practice Address - Fax:229-242-1725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040573207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00656598AMedicaid
GAA98954Medicare UPIN