Provider Demographics
NPI:1770317190
Name:THOMAS, CLARICE J (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CLARICE
Middle Name:J
Last Name:THOMAS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 CANDLEWICK CT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-2682
Mailing Address - Country:US
Mailing Address - Phone:478-731-9306
Mailing Address - Fax:
Practice Address - Street 1:205 TOM HILL SR BLVD STE B
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1932
Practice Address - Country:US
Practice Address - Phone:404-464-0304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF4240419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily