Provider Demographics
NPI:1033738570
Name:THOMAS, ANGEL (ARDMS, RVT)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:ARDMS, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LAKE SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-3612
Mailing Address - Country:US
Mailing Address - Phone:912-704-1053
Mailing Address - Fax:
Practice Address - Street 1:21 LAKE SHORE BLVD
Practice Address - Street 2:
Practice Address - City:PORT WENTWORTH
Practice Address - State:GA
Practice Address - Zip Code:31407-3612
Practice Address - Country:US
Practice Address - Phone:912-704-1053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1342972085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound