Provider Demographics
NPI:1679564553
Name:THOMAS, G'ANNE (AUD)
Entity Type:Individual
Prefix:
First Name:G'ANNE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 ROSEWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-1582
Mailing Address - Country:US
Mailing Address - Phone:706-549-3111
Mailing Address - Fax:706-549-0488
Practice Address - Street 1:1061 DOWDY ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-549-3111
Practice Address - Fax:706-549-0488
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01447237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA389677518FMedicaid
GA389677518BMedicaid
FL389677518DMedicaid
GA389677518EMedicaid
GA389677518AMedicaid
GA389677518AMedicaid
GAQ24752Medicare UPIN
GA389677518EMedicaid