Provider Demographics
NPI:1821067091
Name:THOMAS, JOANNA M (MD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-1908
Mailing Address - Country:US
Mailing Address - Phone:479-521-8260
Mailing Address - Fax:479-443-3903
Practice Address - Street 1:1125 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1908
Practice Address - Country:US
Practice Address - Phone:479-521-8260
Practice Address - Fax:479-443-3903
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-8210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR903629OtherFIRST HEALTH
AR120667OtherUNITED HEALTH CARE
AR56381OtherBCBS
AR13801000000OtherQUAL CHOICE
AR122511001Medicaid
AR5048OtherCIGNA
AR80118144OtherRR MCR
AR237403OtherHEALTH LINK
AR5613515OtherAETNA
AR80118144OtherRR MCR
AR56381OtherBCBS