Provider Demographics
NPI:1659717536
Name:THOMAS, PRIYA SUSAN
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:SUSAN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PRIYA
Other - Middle Name:SUSAN
Other - Last Name:KURIAKOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3155 N POINT PKWY
Mailing Address - Street 2:D200
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5481
Mailing Address - Country:US
Mailing Address - Phone:770-667-6967
Mailing Address - Fax:
Practice Address - Street 1:3155 N POINT PKWY
Practice Address - Street 2:D200
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-5481
Practice Address - Country:US
Practice Address - Phone:770-667-6967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA75552208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program