Provider Demographics
NPI:1922624980
Name:THOMASVILLE REGIONAL MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:THOMASVILLE REGIONAL MEDICAL ASSOCIATES LLC
Other - Org Name:THOMASVILLE REGIONAL PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:BREANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-903-2392
Mailing Address - Street 1:300 MED PARK DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36784-5760
Mailing Address - Country:US
Mailing Address - Phone:334-636-2525
Mailing Address - Fax:334-621-7111
Practice Address - Street 1:300 MED PARK DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784-5760
Practice Address - Country:US
Practice Address - Phone:334-636-2525
Practice Address - Fax:334-621-7111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty