Provider Demographics
NPI:1093936049
Name:CARSWELL, THOMAS WILLIAM JR (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:WILLIAM
Last Name:CARSWELL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:214 GREENSPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-1110
Mailing Address - Country:US
Mailing Address - Phone:678-953-0343
Mailing Address - Fax:770-463-4145
Practice Address - Street 1:4153 FLAT SHOALS PARKWAY14 GREENSPRINGS DR
Practice Address - Street 2:BUILDING A SUITE 102
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-4106
Practice Address - Country:US
Practice Address - Phone:404-241-7062
Practice Address - Fax:404-243-0357
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2016-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA026238207Q00000X
GAGA 026238208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I084140Medicare PIN