Individual
THOMAS E. STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4280 N VALDOSTA RD, VALDOSTA, GA 31602-6814
(229) 671-2066
Mailing address
619 19TH ST S, JT 804, BIRMINGHAM, AL 35249-6810
(678) 641-1598
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
69448
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/10/2009
Last updated
06/24/2013
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