Provider Demographics
NPI:1568134682
Name:THOMASVILLE REGIONAL MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:THOMASVILLE REGIONAL MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:BREANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-903-2392
Mailing Address - Street 1:1200 CORPORATE DR STE 470
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2941
Mailing Address - Country:US
Mailing Address - Phone:205-903-2392
Mailing Address - Fax:
Practice Address - Street 1:300 MED PARK DRIVE
Practice Address - Street 2:MOB, SUITE B
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784
Practice Address - Country:US
Practice Address - Phone:205-903-2392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty