Individual
MISS KATHLEEN VERONICA THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2006 BOULDER GATE DR, ELLENWOOD, ELLENWOOD, GA 30294-1683
(917) 650-4364
Mailing address
2006 BOULDER GATE DR, ELLENWOOD, ELLENWOOD, GA 30294-1683
(917) 650-4364
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/25/2009
Last updated
03/25/2009
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