Individual
JOHN THACKER II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
USAF IDMT
Contact information
Practice address
655 7TH ST UNIT 700, ROBINS AFB, GA 31098-2227
(606) 923-3485
Mailing address
200 SAINT AUGUSTINE DR, BONAIRE, GA 31005-3782
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
10/20/2021
Last updated
10/20/2021
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