Provider Demographics
NPI:1598907388
Name:THOMAS, KATHLEEN VERONICA
Entity Type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:VERONICA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 BOULDER GATE DR
Mailing Address - Street 2:ELLENWOOD
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-1683
Mailing Address - Country:US
Mailing Address - Phone:917-650-4364
Mailing Address - Fax:
Practice Address - Street 1:2006 BOULDER GATE DR
Practice Address - Street 2:ELLENWOOD
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-1683
Practice Address - Country:US
Practice Address - Phone:917-650-4364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator