Provider Demographics
NPI:1154753978
Name:THOMAS, MAQUISSA LASHANTA (MS,WHNP)
Entity type:Individual
Prefix:MRS
First Name:MAQUISSA
Middle Name:LASHANTA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS,WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GLEN EAGLE CT STE 5A
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4267
Mailing Address - Country:US
Mailing Address - Phone:770-377-2456
Mailing Address - Fax:
Practice Address - Street 1:200 GLEN EAGLE CT STE 5A
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4267
Practice Address - Country:US
Practice Address - Phone:770-377-2456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN154661363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health