Provider Demographics
NPI:1467201137
Name:THOMAS, NAQUILLA (RDH, EDD)
Entity type:Individual
Prefix:DR
First Name:NAQUILLA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RDH, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 NORTHGATE ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-2484
Mailing Address - Country:US
Mailing Address - Phone:678-763-6539
Mailing Address - Fax:
Practice Address - Street 1:2000 CLAYTON STATE BLVD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-1250
Practice Address - Country:US
Practice Address - Phone:678-466-4911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH008870124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist