Provider Demographics
NPI:1063269678
Name:THOMAS, DESTINY K (CMMA, CPT)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:K
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CMMA, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 PEACH ORCHARD RD STE 89303
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30916-3500
Mailing Address - Country:US
Mailing Address - Phone:706-478-9115
Mailing Address - Fax:706-478-9205
Practice Address - Street 1:3406 KENSINGTON DR S
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-6001
Practice Address - Country:US
Practice Address - Phone:678-979-7255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA397-11154246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy