Provider Demographics
NPI:1588008619
Name:THOMAS, JENNIFER TIAMESE YANCEY (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TIAMESE YANCEY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:TIAMESE
Other - Last Name:YANCEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1175 CASCADE PKWY SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-3090
Mailing Address - Country:US
Mailing Address - Phone:404-731-8016
Mailing Address - Fax:
Practice Address - Street 1:1175 CASCADE PKWY SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311
Practice Address - Country:US
Practice Address - Phone:404-731-8016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA077957208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program