Provider Demographics
NPI:1851800791
Name:DR. EDDIE D. THOMAS, M.D.,P.C.
Entity Type:Organization
Organization Name:DR. EDDIE D. THOMAS, M.D.,P.C.
Other - Org Name:DR. EDDIE D. THOMAS, M.D.,P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KANDIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEDLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-530-7337
Mailing Address - Street 1:391 PEACHTREE ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-0245
Mailing Address - Country:US
Mailing Address - Phone:912-530-7337
Mailing Address - Fax:912-530-7339
Practice Address - Street 1:391 PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0245
Practice Address - Country:US
Practice Address - Phone:912-530-7337
Practice Address - Fax:912-530-7339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053192208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA798956032AMedicaid
GA10059181OtherAMERIGROUP
GA342408OtherWELLCARE