Basic Information
| Provider Information | |||||||||
| NPI: | 1891798492 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | GEOGY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 540 | ||||||||
| Address2: | |||||||||
| City: | JELLICO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377620540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237848492 | ||||||||
| FaxNumber: | 4237848358 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 SUNSET TRL | ||||||||
| Address2: | |||||||||
| City: | JELLICO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377622343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237845771 | ||||||||
| FaxNumber: | 4237846185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 05/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 05/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35929 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 34083 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 34083 | 01 | TN | STATE LICENSE | OTHER | BT9596606 | 01 | KY | DEA | OTHER | 35929 | 01 | KY | STATE LICENSE | OTHER | 64018591 | 05 | KY | MEDICAID | 3856408 | 05 | TN | MEDICAID | BT6812158 | 01 | TN | DEA | OTHER |