Provider Demographics
NPI:1972814424
Name:HERRING, THOMAS EDWARD JR (MS, CRNA)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EDWARD
Last Name:HERRING
Suffix:JR
Gender:M
Credentials:MS, CRNA
Other - Prefix:
Other - First Name:TOMMY
Other - Middle Name:
Other - Last Name:HERRING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4752 MICHELLE ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-6332
Mailing Address - Country:US
Mailing Address - Phone:229-293-9422
Mailing Address - Fax:
Practice Address - Street 1:4752 MICHELLE ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-6332
Practice Address - Country:US
Practice Address - Phone:229-293-9422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA081964367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered