Provider Demographics
NPI:1295923076
Name:INTERNAL MEDICAL CLINIC OF THOMASVILLE, LLC
Entity type:Organization
Organization Name:INTERNAL MEDICAL CLINIC OF THOMASVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-636-0793
Mailing Address - Street 1:411 WILSON AVE W
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36784-2015
Mailing Address - Country:US
Mailing Address - Phone:334-636-5696
Mailing Address - Fax:334-636-0086
Practice Address - Street 1:411 WILSON AVE W
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784-2015
Practice Address - Country:US
Practice Address - Phone:334-636-5696
Practice Address - Fax:334-636-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty