Provider Demographics
NPI:1194754648
Name:BUICE, THOMAS AARON (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:AARON
Last Name:BUICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:522 GREENWOOD ST
Mailing Address - Street 2:STE A
Mailing Address - City:BARNESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30204-1554
Mailing Address - Country:US
Mailing Address - Phone:770-872-3663
Mailing Address - Fax:770-872-3665
Practice Address - Street 1:522 GREENWOOD ST
Practice Address - Street 2:STE A
Practice Address - City:BARNESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30204-1554
Practice Address - Country:US
Practice Address - Phone:770-872-3663
Practice Address - Fax:770-872-3665
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000962255BMedicaid
GA200717378OtherTAX ID
GA000962255BMedicaid
GA08BBQZQMedicare ID - Type Unspecified
GAH73208Medicare UPIN