Individual
THOMAS L ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
105 W CRANFORD AVE, VALDOSTA, GA 31602-2930
(229) 247-7350
(229) 242-1730
Mailing address
105 W CRANFORD AVE, VALDOSTA, GA 31602-2930
(229) 247-7350
(229) 242-1730
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
025093
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00271543A
—
GA
01
—
202I370889
MEDICARE PART B
GA
05
—
264389800
—
FL
Enumeration date
05/10/2006
Last updated
01/04/2011
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