Provider Demographics
NPI:1023042702
Name:THOMAS, JULIE DOAR (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:DOAR
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 162910
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30321-2910
Mailing Address - Country:US
Mailing Address - Phone:912-692-0606
Mailing Address - Fax:912-692-0707
Practice Address - Street 1:800 E 70TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4813
Practice Address - Country:US
Practice Address - Phone:912-692-0606
Practice Address - Fax:912-692-0707
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004671363AM0700X
SC2998363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0091245363AMedicaid