Provider Demographics
NPI:1568569820
Name:THOMAS, CARLY W (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLY
Middle Name:W
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DDS
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Mailing Address - Street 1:3227 N OAK ST EXT
Mailing Address - Street 2:SUITE A
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605
Mailing Address - Country:US
Mailing Address - Phone:229-247-3200
Mailing Address - Fax:229-241-1900
Practice Address - Street 1:3227 N OAK ST EXT
Practice Address - Street 2:SUITE A
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605
Practice Address - Country:US
Practice Address - Phone:229-247-3200
Practice Address - Fax:229-241-1900
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0122801223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00917067AMedicaid