Provider Demographics
NPI:1497862593
Name:THOMAS, BEN DAVID JR (MD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:DAVID
Last Name:THOMAS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:5197 ROSWELL RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2213
Mailing Address - Country:US
Mailing Address - Phone:404-252-1230
Mailing Address - Fax:404-477-4712
Practice Address - Street 1:5197 ROSWELL RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2213
Practice Address - Country:US
Practice Address - Phone:404-252-1230
Practice Address - Fax:404-477-4712
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2014-07-08
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Provider Licenses
StateLicense IDTaxonomies
GA023118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD46324Medicare UPIN
GA$$$$$$$$$FMedicare PIN