Provider Demographics
NPI:1366853186
Name:THOMAS, MERCEDES L (CPNP, IBCLC)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CPNP, IBCLC
Other - Prefix:
Other - First Name:MERCEDES
Other - Middle Name:L
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:2727 SKYVIEW DR UNIT 926
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-5010
Mailing Address - Country:US
Mailing Address - Phone:404-635-6175
Mailing Address - Fax:
Practice Address - Street 1:12774 WISTERIA DR # 2841
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-9998
Practice Address - Country:US
Practice Address - Phone:404-635-6175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR224496163WL0100X, 363LP0200X
GARN198323363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant