Provider Demographics
NPI:1891798492
Name:THOMAS, GEOGY (MD)
Entity Type:Individual
Prefix:DR
First Name:GEOGY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
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:PO BOX 540
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-0540
Mailing Address - Country:US
Mailing Address - Phone:423-784-8492
Mailing Address - Fax:423-784-8358
Practice Address - Street 1:550 SUNSET TRL
Practice Address - Street 2:
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762-2343
Practice Address - Country:US
Practice Address - Phone:423-784-5771
Practice Address - Fax:423-784-6185
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35929207Q00000X
TN34083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN34083OtherSTATE LICENSE
KY35929OtherSTATE LICENSE
KY64018591Medicaid
TN3856408Medicaid
TN3856408Medicaid
TNBT6812158OtherDEA