Provider Demographics
NPI:1588286710
Name:THOMAS, MICHELLE MARIA
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:MARIA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 LONESOME DOVE LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23868-2934
Mailing Address - Country:US
Mailing Address - Phone:804-922-6221
Mailing Address - Fax:
Practice Address - Street 1:327 LONESOME DOVE LN
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:VA
Practice Address - Zip Code:23868-2934
Practice Address - Country:US
Practice Address - Phone:804-922-6221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No171W00000XOther Service ProvidersContractor