Provider Demographics
NPI:1093825846
Name:DEMARCO, THOMAS JOHN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:DEMARCO
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 1:3969 S COBB DR SE STE 202
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6317
Mailing Address - Country:US
Mailing Address - Phone:770-432-5326
Mailing Address - Fax:770-432-5740
Practice Address - Street 1:3969 S COBB DR SE STE 202
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6317
Practice Address - Country:US
Practice Address - Phone:770-432-5326
Practice Address - Fax:770-432-5740
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA32718207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00422518AMedicaid
10BDBCWMedicare ID - Type Unspecified
GA00422518AMedicaid