Provider Demographics
NPI:1083617872
Name:BACKER, THOMAS S (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:S
Last Name:BACKER
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 1:3905 BROOKSIDE PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4425
Mailing Address - Country:US
Mailing Address - Phone:770-751-9131
Mailing Address - Fax:770-751-9132
Practice Address - Street 1:3905 BROOKSIDE PKWY STE 202
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-4425
Practice Address - Country:US
Practice Address - Phone:770-751-9131
Practice Address - Fax:770-751-9132
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2023-02-23
Deactivation Date:2006-03-30
Deactivation Code:
Reactivation Date:2006-06-21
Provider Licenses
StateLicense IDTaxonomies
GA030711174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA110033309OtherRAILROAD MEDICARE
GA4216134OtherAETNA
GATAX ID NUMBEROtherUNITED HEALTHCARE
GATAX ID NUMBEROtherCIGNA
GA484268OtherBCBS
GATAX ID NUMBEROtherUNITED HEALTHCARE
GA4216134OtherAETNA