Individual
JOLLY THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1000 MEDICAL CENTER BLVD, LAWRENCEVILLE, GA 30046-7694
(678) 312-1000
Mailing address
1525 GRAYSON HWY APT 1905, GRAYSON, GA 30017-1907
(267) 237-4350
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN587335
PA
363LA2200X
Adult Health Nurse Practitioner
Primary
RN285678
GA
363LA2200X
Adult Health Nurse Practitioner
SP015375
PA
Other
Enumeration date
10/20/2015
Last updated
12/23/2021
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