Provider Demographics
NPI:1225183767
Name:THOMAS, ANDREA M
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 LAKESHORE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-8832
Mailing Address - Country:US
Mailing Address - Phone:205-871-6926
Mailing Address - Fax:
Practice Address - Street 1:2200 LAKESHORE DR STE 150
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-8832
Practice Address - Country:US
Practice Address - Phone:205-871-6926
Practice Address - Fax:205-871-7981
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY360952084P0800X
AL288082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid
KYI29639Medicare UPIN
KY30615058Medicaid
KY3311Medicare ID - Type UnspecifiedMEDICARE