1043281207 NPI number — THOMAS F DECKER M.D.

Table of content: THOMAS F DECKER M.D. (NPI 1043281207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043281207 NPI number — THOMAS F DECKER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DECKER
Provider First Name:
THOMAS
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043281207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5354 REYNOLDS ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31405-6007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-355-2116
Provider Business Mailing Address Fax Number:
912-355-3653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5354 REYNOLDS ST
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31405-6007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-355-2116
Provider Business Practice Location Address Fax Number:
912-355-3653
Provider Enumeration Date:
01/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  035851 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 16324 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085B0100X , with the licence number: 035851 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085U0001X , with the licence number: 035851 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00334799 . This is a "RR MCARE-SCI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 908957800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: G35851 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000511585 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300029144 . This is a "RR MCARE-CRP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: P00866848 . This is a "RR MCARE-OIS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com