Provider Demographics
NPI:1336246321
Name:THOMAS, TERISA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:TERISA
Middle Name:ANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 GOODYEAR AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903
Mailing Address - Country:US
Mailing Address - Phone:256-549-0067
Mailing Address - Fax:256-549-0206
Practice Address - Street 1:800 GOODYEAR AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903
Practice Address - Country:US
Practice Address - Phone:256-549-0067
Practice Address - Fax:256-549-0206
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00023391174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529917180Medicaid
ALH29986Medicare UPIN
AL529917180Medicaid