Provider Demographics
NPI:1104394790
Name:THOMAS, DARIUS LARON (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DARIUS
Middle Name:LARON
Last Name:THOMAS
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2599 OAK ST
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3026
Mailing Address - Country:US
Mailing Address - Phone:404-576-8145
Mailing Address - Fax:678-515-4149
Practice Address - Street 1:2599 OAK ST
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3026
Practice Address - Country:US
Practice Address - Phone:225-806-1769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2022-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202009115235Z00000X
DCSLP001252235Z00000X
MD08834235Z00000X
CA32120235Z00000X
GASLP011484235Z00000X
LA8990235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist