Provider Demographics
NPI:1205814175
Name:CARICO, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:CARICO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:CARICO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2697
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-2697
Mailing Address - Country:US
Mailing Address - Phone:912-531-3881
Mailing Address - Fax:703-991-7215
Practice Address - Street 1:112 S ZETTEROWER AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4816
Practice Address - Country:US
Practice Address - Phone:912-489-2400
Practice Address - Fax:703-991-7215
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-02
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041528207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00917188AMedicaid
GA071975OtherBLUE CROSS BLUE SHIELD
GA69WBDLCMedicare ID - Type Unspecified
GA00917188AMedicaid