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Individual

DR. THOMAS LEWIS SISTRUNK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
705 DIXIE ST, CARROLLTON, GA 30117-3818
(770) 836-9660
(770) 812-5028
Mailing address
119 MAPLE ST, SUITE 205, CARROLLTON, GA 30117-3230
(770) 831-0751

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
019424
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000229567B
GA
01
028143
BLUE CROSS BLUE SHIELD
GA
Enumeration date
02/16/2006
Last updated
01/28/2011
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