Provider Demographics
NPI:1912365735
Name:THOMAS, AUTUMN (PA)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:
Other - Last Name:SINGLETARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1400 FRONT AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093
Mailing Address - Country:US
Mailing Address - Phone:410-296-7190
Mailing Address - Fax:443-991-7768
Practice Address - Street 1:5910 SUWANEE DAM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-5648
Practice Address - Country:US
Practice Address - Phone:470-326-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant