Basic Information
| Provider Information | |||||||||
| NPI: | 1659627248 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | TINA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5667 PEACHTREE DUNWOODY RD STE 260 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042551030 | ||||||||
| FaxNumber: | 6788436619 | ||||||||
| Practice Location | |||||||||
| Address1: | 5667 PEACHTREE DUNWOODY RD STE 260 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042551030 | ||||||||
| FaxNumber: | 6788436619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2012 | ||||||||
| LastUpdateDate: | 03/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 76826 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 003180980A | 05 | GA | MEDICAID |