Individual
DR. THOMAS J FEDERICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
310 GOLD CREEK TRL, SUITE 100, WOODSTOCK, GA 30188-5435
(770) 926-9495
Mailing address
104 GOLD SPRINGS CT, CANTON, GA 30114-6333
(407) 697-4345
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
065543
GA
207Q00000X
Family Medicine Physician
ME0047275
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
47762
BCBS
—
Enumeration date
08/28/2006
Last updated
11/26/2012
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