Provider Demographics
NPI:1013072339
Name:FARR, TOMMY WAYNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:WAYNE
Last Name:FARR
Suffix:
Gender:M
Credentials:DMD
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 1187
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286
Mailing Address - Country:US
Mailing Address - Phone:706-647-5573
Mailing Address - Fax:706-647-1362
Practice Address - Street 1:98 SHORT E ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286
Practice Address - Country:US
Practice Address - Phone:706-647-5573
Practice Address - Fax:706-647-1362
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA87611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00175942AMedicaid