Provider Demographics
NPI:1033491600
Name:HOTARD, THOMAS GABRIEL I
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GABRIEL
Last Name:HOTARD
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1378
Mailing Address - Street 2:400 S. PINETREE BLVD. SOUTHWESTERN STATE HOSPITAL,
Mailing Address - City:THOMASVILLE,
Mailing Address - State:GA
Mailing Address - Zip Code:31799-1378
Mailing Address - Country:US
Mailing Address - Phone:229-227-2817
Mailing Address - Fax:229-227-3206
Practice Address - Street 1:400 S PINETREE BLVD
Practice Address - Street 2:DENTAL CLINIC, BLDG. 510
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-7128
Practice Address - Country:US
Practice Address - Phone:229-227-2817
Practice Address - Fax:229-227-3206
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000732122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist