Provider Demographics
NPI:1164402343
Name:THOMAS, HYACINTH (FNP-C)
Entity Type:Individual
Prefix:
First Name:HYACINTH
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 OLD NORCROSS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4386
Mailing Address - Country:US
Mailing Address - Phone:770-339-1387
Mailing Address - Fax:770-962-7868
Practice Address - Street 1:771 OLD NORCROSS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4386
Practice Address - Country:US
Practice Address - Phone:770-339-1387
Practice Address - Fax:770-962-7868
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN192999363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ66544Medicare UPIN