Provider Demographics
NPI:1366194805
Name:THOMAS, CYNTHIA
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1698 GA HIGHWAY 88 UNIT B
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:GA
Mailing Address - Zip Code:30805-3659
Mailing Address - Country:US
Mailing Address - Phone:762-444-8379
Mailing Address - Fax:
Practice Address - Street 1:1698 GA HIGHWAY 88 UNIT B
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:GA
Practice Address - Zip Code:30805-3659
Practice Address - Country:US
Practice Address - Phone:762-444-8379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider