Provider Demographics
NPI:1285610055
Name:PRICE, THOMAS WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:WILLIAM
Last Name:PRICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:458 HEMLOCK ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-4200
Mailing Address - Country:US
Mailing Address - Phone:478-741-5945
Mailing Address - Fax:478-743-5890
Practice Address - Street 1:458 HEMLOCK ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-4200
Practice Address - Country:US
Practice Address - Phone:478-741-5945
Practice Address - Fax:478-743-5890
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2024-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA030662207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000367628AMedicaid
D42228Medicare UPIN
GA$$$$$$$$$AMedicare PIN