Provider Demographics
NPI:1164559738
Name:PEDIGO, THOMAS K (EDD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:K
Last Name:PEDIGO
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 E 65TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4498
Mailing Address - Country:US
Mailing Address - Phone:912-355-5112
Mailing Address - Fax:912-355-5156
Practice Address - Street 1:836 E 65TH ST STE 3
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4498
Practice Address - Country:US
Practice Address - Phone:912-355-5112
Practice Address - Fax:912-355-5156
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002145103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00767786BMedicaid