Provider Demographics
NPI:1750443552
Name:WYATT, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:WYATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1294 HIGHWAY 515 E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-8599
Mailing Address - Country:US
Mailing Address - Phone:404-321-6111
Mailing Address - Fax:404-417-1595
Practice Address - Street 1:1294 HIGHWAY 515 E
Practice Address - Street 2:SUITE 100
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-8599
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-417-1595
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0293952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry