Provider Demographics
NPI:1174314207
Name:THOMAS, BRENDA LEE
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:LEE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:4847 BALD EAGLE
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-3546
Mailing Address - Country:US
Mailing Address - Phone:404-983-5530
Mailing Address - Fax:404-983-5530
Practice Address - Street 1:4847 BALD EAGLE
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-3546
Practice Address - Country:US
Practice Address - Phone:404-983-5530
Practice Address - Fax:404-983-5530
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN178444163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management