Provider Demographics
NPI:1093873879
Name:THOMASVILLE PRIMARY CARE
Entity Type:Organization
Organization Name:THOMASVILLE PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-226-5788
Mailing Address - Street 1:708 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6107
Mailing Address - Country:US
Mailing Address - Phone:229-226-5788
Mailing Address - Fax:229-226-2548
Practice Address - Street 1:708 S BROAD ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6107
Practice Address - Country:US
Practice Address - Phone:229-226-5788
Practice Address - Fax:229-226-2548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID NUMBER
GAGRP7061Medicare ID - Type UnspecifiedGROUP PROVIDER #
GA=========OtherTAX ID NUMBER