Provider Demographics
NPI:1972647436
Name:THOMAS, GAIL (DMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DMD, RPH
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 82
Mailing Address - Street 2:
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-0082
Mailing Address - Country:US
Mailing Address - Phone:706-283-7273
Mailing Address - Fax:706-283-3728
Practice Address - Street 1:556 ELBERT ST
Practice Address - Street 2:
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-2347
Practice Address - Country:US
Practice Address - Phone:706-283-3161
Practice Address - Fax:706-283-3728
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH011240183500000X
GADN010712122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No122300000XDental ProvidersDentist