Provider Demographics
NPI:1407939564
Name:THOMASVILLE FAMILY MEDICINE CENTER, LLC
Entity Type:Organization
Organization Name:THOMASVILLE FAMILY MEDICINE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:REAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-228-4130
Mailing Address - Street 1:951 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6161
Mailing Address - Country:US
Mailing Address - Phone:229-228-4130
Mailing Address - Fax:229-226-4690
Practice Address - Street 1:951 S BROAD ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6161
Practice Address - Country:US
Practice Address - Phone:229-228-4130
Practice Address - Fax:229-226-4690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002549103T00000X
GA019585207Q00000X
GA029087207Q00000X
GA045799207Q00000X
GA046526207Q00000X
GA033433207Q00000X
GA067205207Q00000X
GA067559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA188566OtherBLUE CROSS-GROUP
GA300023240AMedicaid
GA11DO266342OtherCLIA LAB NUMBER
GA300023240AMedicaid