Provider Demographics
NPI:1679854103
Name:THOMAS, LORI ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3226
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38502-3226
Mailing Address - Country:US
Mailing Address - Phone:931-520-1800
Mailing Address - Fax:931-372-1786
Practice Address - Street 1:753 HUMBLE DR STE B
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4202
Practice Address - Country:US
Practice Address - Phone:931-520-1800
Practice Address - Fax:931-372-1786
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2514207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8310821OtherCIGNA
TNQ055538Medicaid
TN4357575OtherBCBS