Thomas, Dennis Russell

Thomas, Dennis Russell is an individual health care provider with primary practice located at 4370 Kings Way , Valdosta GA 31602-6904. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Thomas, Dennis Russell can be contacted via phone (229) 433-8181.

Contact Information

Primary practice address
4370 Kings Way Valdosta GA 31602-6904
Phone: (229) 433-8181
Fax: (229) 293-7801
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 022898 Georgia

Profile Details

NPI number 1821031329
LBN Legal business name Thomas, Dennis Russell
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2006
Last updated Nov 6th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821031329 NPPES
Georgia MEDICAID 117939
Georgia MEDICAID 000260809E
Georgia MEDICAID 336042

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