Provider Information for 1740793439
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MARCUS T THOMAS LPC
Sex: Male
NPI: 1740793439
Last Updated: 2018-03-17
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1740793439 | ||||||||
| Enumeration Date | 2017-11-16 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1316 SOMERVILLE RD SE STE 1 DECATUR, AL 35601-4309 United States Phone: 256-260-7361 | Fax:256-350-5664 | ||||||||
| Primary Practice Address | 1315 13TH AVE SE DECATUR, AL 35601-4308 United States Phone: 256-260-7306 | Fax:256-350-5664 | ||||||||
| Secondary Practice Address(es) | 4110 US HIGHWAY 31 S | ||||||||
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