Provider Demographics
NPI:1023085370
Name:MATHERLY, THOMAS JONES (PA C)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JONES
Last Name:MATHERLY
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Gender:M
Credentials:PA C
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Mailing Address - Street 1:2817 REILLY ROAD MCXC COD CREDENTIALS
Mailing Address - Street 2:WOMACK ARMY MEDICAL CENTER
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310
Mailing Address - Country:US
Mailing Address - Phone:910-907-8922
Mailing Address - Fax:910-907-6069
Practice Address - Street 1:2817 REILLY ROAD
Practice Address - Street 2:WOMACK ARMY MEDICAL CENTER DOOH PES MEB
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310
Practice Address - Country:US
Practice Address - Phone:910-907-8602
Practice Address - Fax:910-907-8602
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NC102314363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant