Provider Demographics
NPI:1386724821
Name:THOMAS, GENVER (ARNP)
Entity type:Individual
Prefix:MRS
First Name:GENVER
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 BLOCKERS BRANCH
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815
Mailing Address - Country:US
Mailing Address - Phone:706-592-4256
Mailing Address - Fax:
Practice Address - Street 1:300 HOSPITAL ROAD
Practice Address - Street 2:DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-2634
Practice Address - Fax:706-787-5127
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006957363LF0000X
GANP156631363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily