Provider Demographics
NPI:1043373103
Name:GARNER, THOMAS KIRKLAND (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:KIRKLAND
Last Name:GARNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 COLLIER NWRD M200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1673
Mailing Address - Country:US
Mailing Address - Phone:678-686-5857
Mailing Address - Fax:404-603-8141
Practice Address - Street 1:35 COLLIER NWRD M200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1673
Practice Address - Country:US
Practice Address - Phone:678-686-5857
Practice Address - Fax:404-603-8141
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20538207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5820010480000EOtherFED I.D.
GA582001048OtherTAX I.D.
GA731226OtherBLUE CROSS BLUE SHIELD
GA00220184CMedicaid
GAAG 8611445OtherDEA#
GA110167567Medicare ID - Type UnspecifiedMEDICARE RAILROAD
GA731226OtherBLUE CROSS BLUE SHIELD
GA5820010480000EOtherFED I.D.