Provider Demographics
NPI:1992788319
Name:THOMAS, WILMA (CRNA)
Entity type:Individual
Prefix:
First Name:WILMA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 GIN WAY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-2732
Mailing Address - Country:US
Mailing Address - Phone:770-483-8915
Mailing Address - Fax:
Practice Address - Street 1:3700 GIN WAY
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-2732
Practice Address - Country:US
Practice Address - Phone:770-314-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN046507367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000870581EMedicaid
GA43ZCBGM23Medicare ID - Type Unspecified
GAS98906Medicare UPIN