Provider Demographics
NPI:1902165038
Name:JUSTICE, ANDREW THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:THOMAS
Last Name:JUSTICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:910-300-4000
Mailing Address - Fax:910-259-7136
Practice Address - Street 1:507 E FREMONT ST
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-5131
Practice Address - Country:US
Practice Address - Phone:910-300-4000
Practice Address - Fax:910-259-7136
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8771566-1205208000000X
390200000X
NC2015-02394207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program