Provider Demographics
NPI:1033300108
Name:THOMAS, RANDY S (SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:RANDY
Middle Name:S
Last Name:THOMAS
Suffix:
Gender:F
Credentials:SLP-CCC
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 404
Mailing Address - Street 2:680 HIGHWAY 68 NORTH
Mailing Address - City:TENNILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31089-0404
Mailing Address - Country:US
Mailing Address - Phone:478-552-7679
Mailing Address - Fax:
Practice Address - Street 1:610 SPARTA RD
Practice Address - Street 2:POST OFFICE BOX 636
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-1860
Practice Address - Country:US
Practice Address - Phone:478-240-2176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP000144235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist