Provider Demographics
NPI:1780320077
Name:THOMAS, JULIE DIAWARA (APRN)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:DIAWARA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 RIVER LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6992
Mailing Address - Country:US
Mailing Address - Phone:678-983-4499
Mailing Address - Fax:
Practice Address - Street 1:1110 RIVER LAUREL DR
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6992
Practice Address - Country:US
Practice Address - Phone:678-983-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN173957363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology