Provider Demographics
NPI:1740796788
Name:THOMAS, PENNY T
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:T
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 TEFEL EAST DR
Mailing Address - Street 2:
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643-4854
Mailing Address - Country:US
Mailing Address - Phone:706-961-8602
Mailing Address - Fax:
Practice Address - Street 1:169 TEFEL EAST DR
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-4854
Practice Address - Country:US
Practice Address - Phone:706-961-8602
Practice Address - Fax:706-961-9395
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN093555164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse