Provider Demographics
NPI:1609851047
Name:UNION, THOMAS SARD JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SARD
Last Name:UNION
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 VINEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-3124
Mailing Address - Country:US
Mailing Address - Phone:478-742-3631
Mailing Address - Fax:478-741-9513
Practice Address - Street 1:2180 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-3124
Practice Address - Country:US
Practice Address - Phone:478-742-3631
Practice Address - Fax:478-741-9513
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA336213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA480008724OtherPALMETTO MEDICARE
GA00006168AMedicaid
GA00006168CMedicaid
GA480008726OtherPALMETTO MEDICARE
GA00006168BMedicaid
GA000336240BMedicare PIN
GA480008724OtherPALMETTO MEDICARE
GA00006168AMedicaid