Provider Demographics
NPI:1043320138
Name:RYAN, THOMAS DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DONALD
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:20 COLLINS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2486
Mailing Address - Country:US
Mailing Address - Phone:770-607-0795
Mailing Address - Fax:770-607-1339
Practice Address - Street 1:20 COLLINS DR
Practice Address - Street 2:SUITE B
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2486
Practice Address - Country:US
Practice Address - Phone:770-607-0795
Practice Address - Fax:770-607-1339
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA042415208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA002618OtherBCBSGA
GA10032515OtherAMERIGROUP
GA12-01508OtherUNITED HEALTH CARE
GA303401OtherWELLCARE OF GA
GA5925435OtherCIGNA
GA002618OtherBCBSGA
GA37BBGJWMedicare ID - Type Unspecified