Provider Demographics
NPI:1689848467
Name:THOMAS, JAMILLA JEAN
Entity Type:Individual
Prefix:MRS
First Name:JAMILLA
Middle Name:JEAN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JAMILLA
Other - Middle Name:JEAN
Other - Last Name:WHARTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COSMETOLOGIST
Mailing Address - Street 1:113 CENTURION DRIVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35757
Mailing Address - Country:US
Mailing Address - Phone:256-348-2301
Mailing Address - Fax:
Practice Address - Street 1:113 CENTURION DRIVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35757
Practice Address - Country:US
Practice Address - Phone:256-348-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
7270846OtherDRIVER LICENSE