1538699442 NPI number — MR. ROBERT GLYNN THOMAS III LCSW

Table of content: MR. ROBERT GLYNN THOMAS III LCSW (NPI 1538699442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538699442 NPI number — MR. ROBERT GLYNN THOMAS III LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
ROBERT
Provider Middle Name:
GLYNN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
LCSW
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:
1538699442
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4417 IVYWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30062-6434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-434-6305
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8046 ROSWELL RD STE 101C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDY SPRINGS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30350-3930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-434-6305
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2017

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: 1041C0700X , with the licence number:  CSW005531 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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