Provider Demographics
NPI:1316942444
Name:KLAS, PAUL THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:THOMAS
Last Name:KLAS
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 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:608-775-4429
Practice Address - Street 1:1439 JESSE JEWELL PKWY NE STE 102
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3806
Practice Address - Country:US
Practice Address - Phone:770-219-9445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA92613207Q00000X
VA0101037646207Q00000X
WI49962-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005600944Medicaid
VA080183668OtherRAILROAD MEDICARE
VA076611OtherANTHEM BLUE CROSS BLUE SH
VA9482244005OtherCIGNA HEALTHCARE
VA142740OtherSOUTHERN HEALTH/COVENTRY
VA45097OtherOPTIMA HEALTH
VA005600944Medicaid
VA142740OtherSOUTHERN HEALTH/COVENTRY