Provider Demographics
NPI:1114040292
Name:THOMAS J MABRY & ASSOCIATES, INC.
Entity type:Organization
Organization Name:THOMAS J MABRY & ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:REICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-268-0291
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:1340 N GRUNDY QUARLES HIGHWAY
Mailing Address - City:GAINESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38562
Mailing Address - Country:US
Mailing Address - Phone:931-268-0291
Mailing Address - Fax:931-268-9241
Practice Address - Street 1:1340 N GRUNDY QUARLES HWY
Practice Address - Street 2:
Practice Address - City:GAINESBORO
Practice Address - State:TN
Practice Address - Zip Code:38562
Practice Address - Country:US
Practice Address - Phone:931-268-0291
Practice Address - Fax:931-268-9241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000136314000000X, 313M00000X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440362Medicaid
TN0445272Medicaid
TN445272Medicare Oscar/Certification
TN7440362Medicaid