Provider Demographics
NPI:1477519569
Name:PRICE, THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:PRICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 CLAIRMONT RD FL 11
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4004
Mailing Address - Country:US
Mailing Address - Phone:404-728-7663
Mailing Address - Fax:404-728-4701
Practice Address - Street 1:1670 CLAIRMONT RD FL 11
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-728-7663
Practice Address - Fax:404-728-4701
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053367207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA767974652CMedicaid
GA222969OtherABIM DIPLOMATE NUMBER
GA767974652AMedicaid
GA767974652BMedicaid
GA053367OtherGEORGIA MEDICAL LICENSE
GA053367OtherGEORGIA MEDICAL LICENSE
GA38BDBGCMedicare ID - Type UnspecifiedCMS PROVIDER NUMBER
GA053367OtherGEORGIA MEDICAL LICENSE