Provider Demographics
NPI:1063414324
Name:MEYER, THOMAS P (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:MEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4128
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4128
Mailing Address - Country:US
Mailing Address - Phone:478-745-5476
Mailing Address - Fax:478-745-3768
Practice Address - Street 1:360 HOSPITAL DR BLDG D
Practice Address - Street 2:SUITE 200
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3874
Practice Address - Country:US
Practice Address - Phone:478-745-5476
Practice Address - Fax:478-745-3768
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016394207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG90418Medicare UPIN
GA000095026AMedicaid
GAD40647Medicare UPIN
GA000095026AMedicaid