Provider Demographics
NPI:1700462918
Name:THOMAS, DEMETRIA NICOLE (C-AA)
Entity type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:NICOLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:C-AA
Other - Prefix:
Other - First Name:DEMETRIA
Other - Middle Name:NICOLE
Other - Last Name:HOLLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 SPALDING CREEK CT
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-1176
Mailing Address - Country:US
Mailing Address - Phone:770-851-0802
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2212
Practice Address - Country:US
Practice Address - Phone:404-686-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10608367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant