Provider Demographics
NPI:1609944925
Name:THOMAS, CYNTHERESS N (ICS, HHA)
Entity Type:Individual
Prefix:
First Name:CYNTHERESS
Middle Name:N
Last Name:THOMAS
Suffix:
Gender:F
Credentials:ICS, HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 ABBERLEY WAY 2
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083
Mailing Address - Country:US
Mailing Address - Phone:404-299-8135
Mailing Address - Fax:
Practice Address - Street 1:631 ABBERLEY WAY 2
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083
Practice Address - Country:US
Practice Address - Phone:404-299-8135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL372600000X, 374U00000X
GA372600000X, 374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered372600000XNursing Service Related ProvidersAdult Companion
Not Answered374U00000XNursing Service Related ProvidersHome Health Aide
Not Answered376K00000XNursing Service Related ProvidersNurse's Aide