Provider Demographics
NPI:1346559184
Name:THOMAS, TONYA WILLIAMS
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:WILLIAMS
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 1:7849 CRESCENT HILL DR APT 307
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-8011
Mailing Address - Country:US
Mailing Address - Phone:901-729-7289
Mailing Address - Fax:
Practice Address - Street 1:3205 KIRBY WHITTEN RD
Practice Address - Street 2:102D
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2853
Practice Address - Country:US
Practice Address - Phone:901-515-7701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS800153126347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle