Provider Demographics
NPI:1265532808
Name:THOMAS, NADINE AMERICAN (MD)
Entity type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:AMERICAN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NADINE
Other - Middle Name:KARLENA
Other - Last Name:AMERICAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:165 BLUE RIDGE OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-4431
Mailing Address - Country:US
Mailing Address - Phone:706-946-5602
Mailing Address - Fax:706-374-7628
Practice Address - Street 1:772 MADDOX DR STE 122
Practice Address - Street 2:
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-8196
Practice Address - Country:US
Practice Address - Phone:706-635-6898
Practice Address - Fax:706-635-6885
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA637432080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I088228OtherMEDICARE
GAH45132Medicare UPIN
GA874964188AMedicaid