Provider Demographics
NPI:1326469495
Name:THOMAS, JUANI
Entity Type:Individual
Prefix:
First Name:JUANI
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 N DAVIDSON ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2565
Mailing Address - Country:US
Mailing Address - Phone:202-560-1961
Mailing Address - Fax:202-552-3380
Practice Address - Street 1:709 N DAVIDSON ST
Practice Address - Street 2:SUITE E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2565
Practice Address - Country:US
Practice Address - Phone:202-560-1961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No171M00000XOther Service ProvidersCase Manager/Care Coordinator