Provider Demographics
NPI:1427207422
Name:WIEME, THOMAS J (PA-C)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:WIEME
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3736 MIKE PADGETT HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-0719
Mailing Address - Country:US
Mailing Address - Phone:706-560-2273
Mailing Address - Fax:706-560-0903
Practice Address - Street 1:3736 MIKE PADGETT HWY
Practice Address - Street 2:SUITE A
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-0719
Practice Address - Country:US
Practice Address - Phone:706-560-2273
Practice Address - Fax:706-560-0903
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1768363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant