Basic Information
| Provider Information | |||||||||
| NPI: | 1447838115 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | CANDLER GREGORY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3334 HIGHWAY 155 | ||||||||
| Address2: | |||||||||
| City: | LOCUST GROVE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302483513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703057929 | ||||||||
| FaxNumber: | 7703057969 | ||||||||
| Practice Location | |||||||||
| Address1: | 3334 HIGHWAY 155 | ||||||||
| Address2: | |||||||||
| City: | LOCUST GROVE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302483513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703057929 | ||||||||
| FaxNumber: | 7703057969 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2021 | ||||||||
| LastUpdateDate: | 08/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 10484 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.