Basic Information
| Provider Information | |||||||||
| NPI: | 1215907365 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHOLES | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | EARLE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 658 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305030658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707181122 | ||||||||
| FaxNumber: | 7705357445 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 JESSE JEWELL PKWY SE | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305013834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702972200 | ||||||||
| FaxNumber: | 7705348139 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2006 | ||||||||
| LastUpdateDate: | 07/29/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 025275 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0700333 | 01 | GA | UNITED HEALTHCARE | OTHER | 4107957 | 01 | GA | AETNA | OTHER | 4253128 | 01 | GA | CIGNA | OTHER | 338806 | 01 | GA | WELLCARE | OTHER | 52238013 | 01 | GA | BCBS | OTHER | 000326356H | 05 | GA | MEDICAID | 00326356I | 05 | GA | MEDICAID | 000326356B | 05 | GA | MEDICAID | 000326356G | 05 | GA | MEDICAID | 10045082 | 01 | GA | AMERIGROUP | OTHER | 160029734 | 01 | GA | RR MEDICARE-GRP # CC4177 | OTHER |