Basic Information
| Provider Information | |||||||||
| NPI: | 1699734095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | WAYNE | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5651 FRIST BLVD | ||||||||
| Address2: | STE 400 | ||||||||
| City: | HERMITAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370762054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153914545 | ||||||||
| FaxNumber: | 6153914546 | ||||||||
| Practice Location | |||||||||
| Address1: | 353 NEW SHACKLE ISLAND RD STE 141C | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370752366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158264205 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 09/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA0000001124 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.