Individual
DR. WILLIAM RUSSELL THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-5674
(706) 721-8623
Mailing address
1120 15TH ST STE BI-1056, AUGUSTA, GA 30912-0004
(706) 721-8623
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
059218
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59218
GA MEDICAL LICENSE
GA
Enumeration date
11/17/2005
Last updated
12/18/2019
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