Provider Demographics
NPI:1912940941
Name:WALSH, THOMAS R (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:WALSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 7217
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-7217
Mailing Address - Country:US
Mailing Address - Phone:706-596-4225
Mailing Address - Fax:706-323-3425
Practice Address - Street 1:2300 MANCHESTER EXPY
Practice Address - Street 2:STE A6
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6802
Practice Address - Country:US
Practice Address - Phone:706-596-4225
Practice Address - Fax:706-323-3425
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA035537207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA388406095Medicaid
GA511I200027OtherMEDICARE PTAN
AL100941Medicaid
GA52451144-012OtherBLUE CROSS BLUE SHIELD OF GEORGIA
GAP00454062OtherRAILROAD MEDICARE