Individual
DR. THOMAS L HALTOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1401 JOHNSON FERRY RD, SUITE 390, MARIETTA, GA 30062-6495
(770) 971-5494
(770) 971-0467
Mailing address
1401 JOHNSON FERRY RD, SUITE 390, MARIETTA, GA 30062-6495
(770) 971-5494
(770) 971-0467
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
028779
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52572062014
BLUECROSS BLUESHIELD
GA
Enumeration date
07/26/2006
Last updated
07/08/2007
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