Provider Demographics
NPI:1104332196
Name:THOMAS, SILAS JAMES JR
Entity type:Individual
Prefix:MR
First Name:SILAS
Middle Name:JAMES
Last Name:THOMAS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9420 LINDALE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4161
Mailing Address - Country:US
Mailing Address - Phone:225-442-3540
Mailing Address - Fax:225-423-5462
Practice Address - Street 1:4348 S JEFFREY DR STE 102
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816
Practice Address - Country:US
Practice Address - Phone:225-361-0219
Practice Address - Fax:225-361-0483
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203783163251S00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator