Provider Demographics
NPI:1104096304
Name:THOMAS, CHARMAINE BETTY (FNP-C)
Entity type:Individual
Prefix:MS
First Name:CHARMAINE
Middle Name:BETTY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:304 TURNER MCCALL BLVD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0233
Mailing Address - Country:US
Mailing Address - Phone:706-509-3278
Mailing Address - Fax:706-292-7600
Practice Address - Street 1:304 TURNER MCCALL BLVD SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-5621
Practice Address - Country:US
Practice Address - Phone:706-509-3278
Practice Address - Fax:706-292-7600
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN163447363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner