Provider Demographics
NPI:1740227859
Name:THOMAS, ANASTASIA M (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANASTASIA
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:ANASTASIA
Other - Middle Name:M
Other - Last Name:THOMAS-LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:4045 FIVE FORKS TRICKUM RD SW
Mailing Address - Street 2:SUITE D-17, PMB 248
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2538
Mailing Address - Country:US
Mailing Address - Phone:678-718-5835
Mailing Address - Fax:770-790-0054
Practice Address - Street 1:5385 FIVE FORKS TRICKUM RD
Practice Address - Street 2:SUITE F
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3018
Practice Address - Country:US
Practice Address - Phone:678-404-8611
Practice Address - Fax:770-790-0054
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006095-1213ES0131X
GAPOD001061213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV08981Medicare UPIN