Basic Information
Provider Information
NPI: 1619356599
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHOI
FirstName: THOMAS
MiddleName: YEONG
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 777 HEMLOCK ST
Address2: MSC 143
City: MACON
State: GA
PostalCode: 312012102
CountryCode: US
TelephoneNumber: 4786335550
FaxNumber: 4787843550
Practice Location
Address1: 777 HEMLOCK ST
Address2: MSC 143
City: MACON
State: GA
PostalCode: 31201
CountryCode: US
TelephoneNumber: 4786335550
FaxNumber: 4787843550
Other Information
ProviderEnumerationDate: 05/25/2015
LastUpdateDate: 07/18/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X81124GAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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