Organization
THOMAS W. BANTLY, M.D., P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS W. BANTLY M.D. (PRESIDENT/CEO)
(770) 738-7534
Entity
Organization
Contact information
Practice address
1700 TREE LANE ROAD, SUITE 260, SNELLVILLE, GA 30078-6782
(770) 736-7534
(770) 736-8627
Mailing address
1700 TREE LANE ROAD, SUITE 260, SNELLVILLE, GA 30078-6782
(770) 736-7534
(770) 736-8627
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000275877B
—
GA
Enumeration date
10/29/2008
Last updated
10/29/2008
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