Provider Demographics
NPI:1215907365
Name:SHOLES, THOMAS EARLE (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:EARLE
Last Name:SHOLES
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:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:770-297-2200
Practice Address - Fax:770-534-8139
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025275207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0700333OtherUNITED HEALTHCARE
GA4107957OtherAETNA
GA4253128OtherCIGNA
GA338806OtherWELLCARE
GA52238013OtherBCBS
GA000326356HMedicaid
GA00326356IMedicaid
GA000326356BMedicaid
GA000326356GMedicaid
GA10045082OtherAMERIGROUP
GA160029734OtherRR MEDICARE-GRP # CC4177
GA4107957OtherAETNA
GA338806OtherWELLCARE