Provider Demographics
NPI:1063773810
Name:MAGRUDER, THOMAS GARLAND V (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GARLAND
Last Name:MAGRUDER
Suffix:V
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 535744
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-5510
Mailing Address - Country:US
Mailing Address - Phone:844-294-5114
Mailing Address - Fax:865-691-0843
Practice Address - Street 1:135 W RAVINE RD
Practice Address - Street 2:STE 5B
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3847
Practice Address - Country:US
Practice Address - Phone:423-224-3460
Practice Address - Fax:423-224-3465
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2017-04-12
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Provider Licenses
StateLicense IDTaxonomies
TN51109207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1063773810Medicaid
TNQ021941Medicaid