Provider Demographics
NPI:1821738105
Name:THOMAS, ABIGAIL A (RDN, LD)
Entity Type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1578 US HIGHWAY 19 S APT 174
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-4983
Mailing Address - Country:US
Mailing Address - Phone:407-292-9226
Mailing Address - Fax:
Practice Address - Street 1:1578 US HIGHWAY 19 S APT 174
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-4983
Practice Address - Country:US
Practice Address - Phone:407-292-9226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002285133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered