Provider Demographics
NPI:1982677803
Name:GAULDIN, THOMAS C (PAC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:GAULDIN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 W MAIN ST STE 21
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1058
Mailing Address - Country:US
Mailing Address - Phone:334-699-7900
Mailing Address - Fax:334-699-7901
Practice Address - Street 1:4300 W MAIN ST STE 21
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1058
Practice Address - Country:US
Practice Address - Phone:334-699-7900
Practice Address - Fax:334-699-7901
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-1238363AS0400X
ALPA756363AS0400X
NC0010-01523363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCS25064Medicare UPIN
NCP00716525 RAILROADMedicare PIN
NC2759296Medicare PIN