Provider Demographics
NPI:1619207701
Name:THOMAS, JONATHAN G (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:G
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3109
Mailing Address - Country:US
Mailing Address - Phone:704-376-1605
Mailing Address - Fax:047-335-8448
Practice Address - Street 1:1130 N CHURCH ST STE 200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1041
Practice Address - Country:US
Practice Address - Phone:336-272-4578
Practice Address - Fax:336-272-5931
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-04352207T00000X, 207T00000X
PAMD457526207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX349482501Medicaid
TX431370YKQHMedicare PIN
PA505964ZM1MMedicare PIN
NJ506376ZLRPMedicare PIN