Provider Demographics
NPI:1194786830
Name:THOMAS, CARLA N (MD)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:N
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 WOODSTOCK AVE
Mailing Address - Street 2:PO BOX 1887
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-1887
Mailing Address - Country:US
Mailing Address - Phone:256-237-0215
Mailing Address - Fax:256-237-0295
Practice Address - Street 1:1401 WOODSTOCK AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-3947
Practice Address - Country:US
Practice Address - Phone:256-237-0215
Practice Address - Fax:256-237-0295
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11263207P00000X, 207Q00000X
GA057197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000014945Medicaid
AL000014945Medicaid
AL000014945Medicare PIN
ALC72854Medicare UPIN