Individual
DENNIS RUSSELL THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4370 KINGS WAY, VALDOSTA, GA 31602-6904
(229) 433-8181
(229) 293-7801
Mailing address
4370 KINGS WAY, VALDOSTA, GA 31602-6904
(229) 433-8181
(229) 293-7801
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
022898
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000260809E
—
GA
05
—
117939
—
GA
05
—
336042
—
GA
Enumeration date
06/13/2006
Last updated
11/06/2020
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