Provider Demographics
NPI:1922295617
Name:THOMAS J. DEMARCO
Entity Type:Organization
Organization Name:THOMAS J. DEMARCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEMARCO, M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-432-5326
Mailing Address - Street 1:3969 S COBB DR SE STE 202
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6317
Mailing Address - Country:US
Mailing Address - Phone:770-432-5326
Mailing Address - Fax:770-432-5740
Practice Address - Street 1:3969 S COBB DR SE STE 202
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6317
Practice Address - Country:US
Practice Address - Phone:770-432-5326
Practice Address - Fax:770-432-5740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA32718207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10BDBCWOtherMEDICARE PROVIDER NUMBER
GAGRP4756OtherGROUP NUMBER